Basic Information
| Provider Information | |||||||||
| NPI: | 1275966533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | TRACY | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 477 LOIS ST | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833017636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085395993 | ||||||||
| FaxNumber: | 2087349441 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 POLK ST STE A | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087370572 | ||||||||
| FaxNumber: | 2087349441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2013 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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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 | 101YP2500X | LCPC-5383 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.