Provider Demographics
NPI:1487735387
Name:THOMPSON, ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50814
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0814
Mailing Address - Country:US
Mailing Address - Phone:719-799-0066
Mailing Address - Fax:719-752-7605
Practice Address - Street 1:2640 EDENDERRY DR # DT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3867
Practice Address - Country:US
Practice Address - Phone:719-799-0066
Practice Address - Fax:719-752-7605
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20831041C0700X
COCSW099239471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical