Provider Demographics
NPI:1487905717
Name:ALLISON THOMPSON, AMY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ALLISON THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3179
Mailing Address - Country:US
Mailing Address - Phone:406-531-4557
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3179
Practice Address - Country:US
Practice Address - Phone:406-531-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-46361041C0700X
MT4636104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011004873Medicare PIN
MT0000701633OtherBLUE CROSS-SHIELD OF MONTANA
MTP01505840OtherRAILROAD MEDICARE