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General NPI Number Information
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NPI Number | 1841663960
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Entity Type | Organization
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Legal Business Name | WESLEY THOMPSON PSYD LLC
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 2804 FORUM BLVD STE 3A
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City | COLUMBIA
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State | MO
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Zip | 65203-6322
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Country | US
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Telephone | 573-446-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 2804 FORUM BLVD STE 3A
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City | COLUMBIA
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State | MO
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Zip | 65203-6322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. WESLEY THOMPSON
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Credential | PSY.D.
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Telephone | 573-446-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2014031972
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License Number State | MO
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