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General NPI Number Information
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NPI Number | 1477964898
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Entity Type | Individual
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Provider Name | KATRISE THOMPSON M.ED.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 211 FOOTHILLS MALL DRIVE
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City | MARYVILLE
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State | TN
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Zip | 37801-3770
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Country | US
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Telephone | 865-263-6471
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Fax |
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Provider Business Mailing Address
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Address Line | 257 N CALDERWOOD ST # 239
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City | ALCOA
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State | TN
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Zip | 37701-2111
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Country | US
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Telephone | 865-405-3564
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5436
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License Number State | TN
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