Provider Demographics
NPI:1275356347
Name:JEFFREY DAVID THOMPSON PHD PLLC
Entity type:Organization
Organization Name:JEFFREY DAVID THOMPSON PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-308-0276
Mailing Address - Street 1:1552 W GOODLANDER RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-8760
Mailing Address - Country:US
Mailing Address - Phone:509-961-5928
Mailing Address - Fax:509-737-1494
Practice Address - Street 1:1552 W GOODLANDER RD
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-8760
Practice Address - Country:US
Practice Address - Phone:509-961-5928
Practice Address - Fax:509-737-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)