Provider Demographics
NPI:1972612901
Name:THOMPSON, MICHAEL GREGORY (LCPC , CRADC , SAP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GREGORY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCPC , CRADC , SAP
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Mailing Address - Street 1:4230 LINCOLNSHIRE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2189
Mailing Address - Country:US
Mailing Address - Phone:618-242-4290
Mailing Address - Fax:618-242-4209
Practice Address - Street 1:4230 LINCOLNSHIRE DR
Practice Address - Street 2:SUITE E
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-242-4290
Practice Address - Fax:618-242-4209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04128084OtherBLUE CROSS BLUE SHIELD
IL5266705OtherAETNA