Provider Demographics
NPI:1376873489
Name:THOMPSON, JEFFREY D (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 W GOODLANDER RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-8760
Mailing Address - Country:US
Mailing Address - Phone:509-961-5928
Mailing Address - Fax:509-737-1494
Practice Address - Street 1:1552 W GOODLANDER RD
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-8760
Practice Address - Country:US
Practice Address - Phone:509-525-6650
Practice Address - Fax:509-737-1494
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health