MEDICARE: DR. SHELIA BERNERDETTE THOMPSON MSSW, ED.D.

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	103TB0200X	Cognitive & Behavioral Psychologist	1601587273	NV

General Provider Information

NPI Number	:	1275878951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELIA BERNERDETTE THOMPSON MSSW, ED.D.

Provider Business Mailing Address
First Line	:	3077 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3752
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:	702-998-6270

Provider Business Practice Location Address
First Line	:	3077 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3752
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:	702-998-6270

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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