MEDICARE: MS. KISHA 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	66249	CA

General Provider Information

NPI Number	:	1902002165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KISHA THOMPSON

Provider Business Mailing Address
First Line	:	1720 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3052
Country	:	US
Telephone Number	:	213-238-2481
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3052
Country	:	US
Telephone Number	:	213-238-2481
Fax Number	:	310-669-9501

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	03/07/2022

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Directions to “ MS. KISHA THOMPSON ” Practice Location

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