Provider Demographics
NPI:1285940346
Name:THIGPEN, SALLY ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ELIZABETH
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4442
Mailing Address - Country:US
Mailing Address - Phone:318-254-1234
Mailing Address - Fax:318-254-1235
Practice Address - Street 1:203 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4442
Practice Address - Country:US
Practice Address - Phone:318-254-1234
Practice Address - Fax:318-254-1235
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1027101YP2500X
LA476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional