MEDICARE: MICHELLE THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013459288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE THOMPSON

Provider Business Mailing Address
First Line	:	5915 UNION AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 UNION AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3927
Country	:	US
Telephone Number	:	318-799-2053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	01/03/2019

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Directions to “ MICHELLE THOMPSON ” Practice Location

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