Provider Demographics
NPI:1992588792
Name:THOMPSON, TOMMY L III (NBC-HWC)
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:L
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 NE 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9421
Mailing Address - Country:US
Mailing Address - Phone:971-421-0101
Mailing Address - Fax:
Practice Address - Street 1:11521 NE 133RD AVE
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9421
Practice Address - Country:US
Practice Address - Phone:971-421-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3344236171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach