Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LMHC18352 | FL |
NPI | 1003413923 |
---|---|
Provider Name | Kristen Thompson |
First Address | Pensacola, FL 32506-6220 |
Second Address | Pensacola, FL 32506-6220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2020 |
Last Update Date | 04/10/2020 |