Provider Demographics
NPI:1588868228
Name:THOMPSON, MICHELLE EILEEN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EILEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:EILEEN
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72360 NICHOLSON DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2412
Mailing Address - Country:US
Mailing Address - Phone:760-367-2027
Mailing Address - Fax:
Practice Address - Street 1:73501 29 PALMS HWY
Practice Address - Street 2:STE. A
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-3100
Practice Address - Country:US
Practice Address - Phone:760-367-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker