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General NPI Number Information
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NPI Number | 1437449006
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Entity Type | Individual
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Provider Name | KELSEY LEIGH THOMPSON M.S., CRC, CCM, LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 1822 W CHASE AVE UNIT G
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City | CHICAGO
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State | IL
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Zip | 60626-2369
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Country | US
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Telephone | 773-550-5456
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Fax | 312-243-8539
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Provider Business Mailing Address
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Address Line | 1822 W CHASE AVE UNIT G
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City | CHICAGO
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State | IL
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Zip | 60626-2369
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Country | US
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Telephone | 773-550-5456
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Fax | 312-243-8539
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.007486
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License Number State | IL
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