Provider Demographics
NPI:1750554184
Name:THOMPSON, NIKKI JEAN (LMFT, ATR-BC)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 BANYAN DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1105
Mailing Address - Country:US
Mailing Address - Phone:760-723-1225
Mailing Address - Fax:760-723-8540
Practice Address - Street 1:1453 BANYAN DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-1105
Practice Address - Country:US
Practice Address - Phone:760-687-8254
Practice Address - Fax:760-723-8540
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist