MEDICARE: ELLIE VILANNA 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

General Provider Information

NPI Number	:	1184089336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE VILANNA THOMPSON LMHC

Provider Business Mailing Address
First Line	:	4514 HOLLOW STUMP RUN
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-1296
Country	:	US
Telephone Number	:	804-366-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-578-8333
Fax Number	:

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

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	09/11/2025

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