MEDICARE: JOHN P THOMPSON CDP, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00003452	WA
2	101YM0800X	Mental Health Counselor	LH60174986	WA

General Provider Information

NPI Number	:	1326381385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P THOMPSON CDP, LMHC

Provider Business Mailing Address
First Line	:	7512 MIRIMICHI DR NW APT 3
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1822 BLACK LAKE BLVD SW STE 101
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5628
Country	:	US
Telephone Number	:	360-704-0086
Fax Number	:

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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