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General NPI Number Information
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NPI Number | 1467287177
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Entity Type | Individual
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Provider Name | SUSANNA THOMPSON LPC (TEMP) MHSP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 6363 POPLAR AVE STE 404
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City | MEMPHIS
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State | TN
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Zip | 38119-4831
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Country | US
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Telephone | 901-313-8544
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Fax |
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Provider Business Mailing Address
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Address Line | 9383 CANABRIDGE DR
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City | LAKELAND
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State | TN
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Zip | 38002-4374
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Country | US
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Telephone | 901-687-0094
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7120
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License Number State | TN
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