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General NPI Number Information
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NPI Number | 1124513734
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Entity Type | Individual
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Provider Name | PHILLIP ANTONIO THOMPSON MFT
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Gender | Male
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 3146 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1441
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Country | US
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Telephone | 502-776-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 743 E BROADWAY STE 291
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City | LOUISVILLE
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State | KY
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Zip | 40202-1711
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Country | US
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Telephone | 502-608-7640
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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