MEDICARE: DARYN LEE THOMPSON M.ED.

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1750935425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYN LEE THOMPSON M.ED.

Provider Business Mailing Address
First Line	:	15 DAISY PL
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-1365
Country	:	US
Telephone Number	:	678-675-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 GALLATIN PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2405
Country	:	US
Telephone Number	:	615-682-2103
Fax Number	:

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

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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