MEDICARE: MS. JOHANNAH RUTH THOMPSON MA

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	106H00000X	Marriage & Family Therapist	44304	CA
2	106H00000X	Marriage & Family Therapist	2553	NV

General Provider Information

NPI Number	:	1245380740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOHANNAH RUTH THOMPSON MA

Provider Business Mailing Address
First Line	:	6859 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	415-310-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	6859 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	415-310-1965
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/03/2021

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