=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245445279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. DANIEL J THOMPSON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2007
-----------------------------------------------------
Last Update Date | 04/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 WURZBACH RD SUITE 1103
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-822-5971
-----------------------------------------------------
Fax | 210-614-0691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28247 AXIS DR
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-981-8081
-----------------------------------------------------
Fax | 830-755-9016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 21198
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------