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NPI Code Detail

MEDICARE: EDWINA KAYE THOMPSON LPC-S

MEDICARE: EDWINA KAYE THOMPSON LPC-S
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
1101YP2500XProfessional Counselor70417TX

General Provider Information

NPI Number : 1184063448
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWINA KAYE THOMPSON LPC-S
Provider Business Mailing Address
First Line : 4716 CADILLAC BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-5433
Country : US
Telephone Number : 817-797-0079
Fax Number :
Provider Business Practice Location Address
First Line : 3840 HULEN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7277
Country : US
Telephone Number : 817-569-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2013
Last Update Date : 05/13/2026

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