Basic Information
| Provider Information | |||||||||
| NPI: | 1851806772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | KRISTAIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6471 AMERICAN EAGLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891313252 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 6471 AMERICAN EAGLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891313252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008920640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2017 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | LBA0531 | NV | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.