=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851679823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXA LYNN THOMPSON LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2011
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22043 JORDAN LN
-----------------------------------------------------
City | RICHTON PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60471-1269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-680-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 CHAMPAGNE DR
-----------------------------------------------------
City | LAKE SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63367-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-680-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2011029171
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.012074
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------