MEDICARE: JAY S THOMPSON BA

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	:	1437591443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY S THOMPSON BA

Provider Business Mailing Address
First Line	:	6239 EDGEWATER DR
Second Line	:	SUITE D-15
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-578-6411
Fax Number	:	407-578-6475

Provider Business Practice Location Address
First Line	:	6239 EDGEWATER DR
Second Line	:	SUITE D-15
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-578-6411
Fax Number	:	407-578-6475

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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