Provider Demographics
NPI:1992180178
Name:THOMPSON, BRENNAN
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W 57TH ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3146
Mailing Address - Country:US
Mailing Address - Phone:605-600-1713
Mailing Address - Fax:605-653-1700
Practice Address - Street 1:3220 W 57TH ST STE 100A
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3146
Practice Address - Country:US
Practice Address - Phone:605-600-1713
Practice Address - Fax:605-653-1700
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor