Provider Demographics
NPI:1558104786
Name:THOMPSON, TANNER (LMSW)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4609
Mailing Address - Country:US
Mailing Address - Phone:575-437-7404
Mailing Address - Fax:575-439-2860
Practice Address - Street 1:2360 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4609
Practice Address - Country:US
Practice Address - Phone:575-437-7404
Practice Address - Fax:575-439-2860
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-0320104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker