Provider Demographics
NPI:1194334672
Name:THOMPSON, THERESA LYNN (RMHCI)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 FREDDIE ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2724
Mailing Address - Country:US
Mailing Address - Phone:321-777-0119
Mailing Address - Fax:321-821-4890
Practice Address - Street 1:212 FREDDIE ST
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2724
Practice Address - Country:US
Practice Address - Phone:321-777-0119
Practice Address - Fax:321-821-4890
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health