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NPI Code Detail

MEDICARE: MYRA THOMPSON LCSW, PSYD

MEDICARE:   MYRA  THOMPSON  LCSW, PSYD
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
11041C0700XClinical Social Worker27278CA
21041C0700XClinical Social Worker6578-CNV
3103TC0700XClinical PsychologistPY0739NV

General Provider Information

NPI Number : 1720393382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRA THOMPSON LCSW, PSYD
Provider Business Mailing Address
First Line : PO BOX 400755
Second Line :
City : LAS VEGAS
State : NV
Zip : 89140-0755
Country : US
Telephone Number : 702-444-1373
Fax Number :
Provider Business Practice Location Address
First Line : 2920 S JONES BLVD STE 110B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146
Country : US
Telephone Number : 702-443-1373
Fax Number : 702-960-7229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2010
Last Update Date : 08/22/2018

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Directions to “ MYRA THOMPSON LCSW, PSYD” Practice Location

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