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General NPI Number Information
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NPI Number | 1083140289
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Entity Type | Individual
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Provider Name | MIRIAH ANN THOMPSON, MS, LPC, ATR M.S., LPC, ATR
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Gender | Female
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 204 E CAPITOL DR STE 104
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City | MILWAUKEE
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State | WI
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Zip | 53212-1200
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Country | US
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Telephone | 859-321-1015
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Fax |
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Provider Business Mailing Address
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Address Line | 5106 N DIVERSEY BLVD
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-5545
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Country | US
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Telephone | 859-321-1015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6015-125
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License Number State | WI
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