Provider Demographics
NPI:1215328919
Name:THOMPSON, MOIRA K
Entity type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1831
Mailing Address - Country:US
Mailing Address - Phone:314-534-6624
Mailing Address - Fax:314-535-4394
Practice Address - Street 1:4220 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1831
Practice Address - Country:US
Practice Address - Phone:314-534-6624
Practice Address - Fax:314-535-4394
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health