Provider Demographics
NPI:1588726327
Name:THOMPSON, ANDREW HARVEY (MSLP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:HARVEY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5538 COUNTY ROAD 9
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-1367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36666 STATE HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760-5710
Practice Address - Country:US
Practice Address - Phone:218-768-5322
Practice Address - Fax:218-768-6124
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2045103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling