Basic Information
| Provider Information | |||||||||
| NPI: | 1245407816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A., C.M.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807513168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705224549 | ||||||||
| FaxNumber: | 9705226898 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | LIMON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197752313 | ||||||||
| FaxNumber: | 7197752315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0000650 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP1600X | 7099 | CO | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 225700000X | N/A | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.