| Jessica Thompson, Lcsw, Llc | |
|
3300 S Broadway Ave Ste 212 Tyler TX 75701-7818 | |
| (903) 780-1513 | |
| (903) 200-2013 |
| Full Name | Jessica Thompson, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3300 S Broadway Ave Ste 212, Tyler, Texas |
| Authorized Official Name and Position | Jessica Ellen Thompson (LCSW) |
| Authorized Official Contact | 9037801513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Thompson, Lcsw, Llc 3300 S Broadway Ave Ste 212 Tyler TX 75701-7818 Ph: (903) 780-1513 | Jessica Thompson, Lcsw, Llc 3300 S Broadway Ave Ste 212 Tyler TX 75701-7818 Ph: (903) 780-1513 |
| NPI Number | 1568086080 |
|---|---|
| Provider Enumeration Date | 06/01/2020 |
| Last Update Date | 09/01/2022 |
| Certification Date | 09/01/2022 |
| Medicare PECOS PAC ID | 6103248836 |
|---|---|
| Medicare Enrollment ID | O20200625000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568086080 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica E Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790305829 PECOS PAC ID: 4284056920 Enrollment ID: I20200625001158 |
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