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General NPI Number Information
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NPI Number | 1922367911
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Entity Type | Organization
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Legal Business Name | THOMPSON PSYCHOLOGICAL & CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 1148 W BELLA CASA DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3103
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Country | US
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Telephone | 907-590-9468
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Fax | 719-547-7418
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Provider Business Mailing Address
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Address Line | 1148 W BELLA CASA DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3103
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Country | US
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Telephone | 907-590-9468
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Fax | 719-547-7418
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. SALLETTE ANN THOMPSON
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Credential | PSYD
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Telephone | 907-590-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3289
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License Number State | CO
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