Provider Demographics
NPI:1174774178
Name:THOMPSON, LAURIE E
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-0356
Mailing Address - Country:US
Mailing Address - Phone:530-615-7298
Mailing Address - Fax:
Practice Address - Street 1:500 CROWN POINT CIR. STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95713
Practice Address - Country:US
Practice Address - Phone:530-273-5440
Practice Address - Fax:530-273-5440
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health