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General NPI Number Information
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NPI Number | 1043590722
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Entity Type | Organization
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Legal Business Name | ALICIA THOMPSON MD PLLC
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 02/07/2021
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Provider Practice Location Address
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Address Line | 15005 SALEM CREEK RD
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City | EDMOND
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State | OK
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Zip | 73013-2455
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Country | US
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Telephone | 405-657-4537
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Fax | 405-347-7617
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Provider Business Mailing Address
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Address Line | 15005 SALEM CREEK RD
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City | EDMOND
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State | OK
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Zip | 73013-2455
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Country | US
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Telephone | 405-657-4537
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Fax | 405-347-7617
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALICIA D THOMPSON
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Credential | MD
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Telephone | 405-657-4537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25776
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License Number State | OK
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