MEDICARE: CATHERINE NICHOLE THOMPSON

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	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist	100289	CA

General Provider Information

NPI Number	:	1457604035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE NICHOLE THOMPSON

Provider Business Mailing Address
First Line	:	1001 E 2ND ST
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-3002
Country	:	US
Telephone Number	:	978-996-6525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E 2ND ST
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-3002
Country	:	US
Telephone Number	:	978-996-6525
Fax Number	:

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

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	05/04/2021

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Directions to “ CATHERINE NICHOLE THOMPSON ” Practice Location

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