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NPI Code Detail

MEDICARE: DR. DOUGLAS L. THOMPSON PH.D.

MEDICARE: DR. DOUGLAS L. THOMPSON PH.D.
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
1103T00000XPsychologist1018AZ

General Provider Information

NPI Number : 1942235841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS L. THOMPSON PH.D.
Provider Business Mailing Address
First Line : 15411 N 2ND WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-3042
Country : US
Telephone Number : 602-588-9511
Fax Number :
Provider Business Practice Location Address
First Line : 3420 E SHEA BLVD
Second Line : STE 200
City : PHOENIX
State : AZ
Zip : 85028-3348
Country : US
Telephone Number : 602-954-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 05/30/2017

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