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NPI Code Detail

MEDICARE: DR. STACEY RHEA THOMPSON PSYD

MEDICARE: DR. STACEY RHEA THOMPSON PSYD
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
1103TC0700XClinical Psychologist36645TX

General Provider Information

NPI Number : 1184050726
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY RHEA THOMPSON PSYD
Provider Business Mailing Address
First Line : 909 PECAN ST
Second Line :
City : BASTROP
State : TX
Zip : 78602-3819
Country : US
Telephone Number : 719-510-7883
Fax Number :
Provider Business Practice Location Address
First Line : 909 PECAN ST
Second Line :
City : BASTROP
State : TX
Zip : 78602-3819
Country : US
Telephone Number : 719-510-7883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2013
Last Update Date : 09/14/2013

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