MEDICARE: LISA THOMPSON LAC

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	17730	AZ

General Provider Information

NPI Number	:	1821885419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA THOMPSON LAC

Provider Business Mailing Address
First Line	:	303 N CENTENNIAL WAY STE 200
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-6711
Country	:	US
Telephone Number	:	480-527-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 N CENTENNIAL WAY STE 200
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-6711
Country	:	US
Telephone Number	:	480-527-0337
Fax Number	:

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

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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