Provider Demographics
NPI:1992353775
Name:THOMPSON, LARRY S (MS CHW)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MS CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5832 PETRIFIED TREE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6864
Mailing Address - Country:US
Mailing Address - Phone:850-255-1612
Mailing Address - Fax:
Practice Address - Street 1:5832 PETRIFIED TREE LN
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6864
Practice Address - Country:US
Practice Address - Phone:850-255-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker