MEDICARE: IRENE THOMPSON LMHC

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	MH16059	FL

General Provider Information

NPI Number	:	1043786361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE THOMPSON LMHC

Provider Business Mailing Address
First Line	:	3515 W SAN JUAN ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7903
Country	:	US
Telephone Number	:	813-551-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 214
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-551-0421
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	10/15/2018

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