=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215543806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEN THOMPSON LMFT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2020
-----------------------------------------------------
Last Update Date | 09/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11209 N MAY AVE STE B
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-6351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-693-8118
-----------------------------------------------------
Fax | 405-563-7530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2916 GETTYSBURG RD
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-6458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-693-8118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BENJAMIN A THOMPSON
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 405-693-8118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------