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NPI Code Detail

MEDICARE: MS. ALISSA THOMPSON BA

MEDICARE: MS. ALISSA THOMPSON BA
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1144591967
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALISSA THOMPSON BA
Provider Business Mailing Address
First Line : 4315 BLUEBONNET BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9661
Country : US
Telephone Number : 225-223-6968
Fax Number :
Provider Business Practice Location Address
First Line : 4315 BLUEBONNET BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9661
Country : US
Telephone Number : 225-223-6968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 11/11/2019

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