Provider Demographics
NPI:1962591818
Name:THOMPSON, ELLEN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:ELIZABETH
Other - Last Name:GAUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:CA
Mailing Address - Zip Code:93512-0964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:452 OLD MAMMOTH ROAD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-2619
Practice Address - Country:US
Practice Address - Phone:760-924-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist