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General NPI Number Information
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NPI Number | 1982944203
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Entity Type | Individual
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Provider Name | JENNIFER RENE THOMPSON CPSS
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Gender | Female
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Dates
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Enumeration Date | 02/23/2013
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Last Update Date | 02/23/2013
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Provider Practice Location Address
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Address Line | 14799 DIX TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2507
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Country | US
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Telephone | 734-324-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 18710 VAN HORN RD APT 103
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City | WOODHAVEN
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State | MI
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Zip | 48183-3800
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Country | US
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Telephone | 734-925-3896
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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 |
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License Number State | MI
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