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General NPI Number Information
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NPI Number | 1194419416
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Entity Type | Organization
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Legal Business Name | MATT THOMPSON THERAPY PLLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1576 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2547
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Country | US
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Telephone | 817-891-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 3233 JEFFERSON ST
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City | MUSKEGON HEIGHTS
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State | MI
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Zip | 49444-2923
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Country | US
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Telephone | 817-891-4320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW PRESCOTT THOMPSON
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Credential | LLMSW
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Telephone | 817-891-4320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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