Provider Demographics
NPI:1366953390
Name:THOMPSON, RENA KAY (CDPT)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CDPT
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 5242
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0242
Mailing Address - Country:US
Mailing Address - Phone:253-433-2321
Mailing Address - Fax:
Practice Address - Street 1:1001 YAKIMA AVE STE 14
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4869
Practice Address - Country:US
Practice Address - Phone:253-267-5402
Practice Address - Fax:253-328-7301
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60801891101YM0800X
WA60935291101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health