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Individual
THOMPSON SIVERSON
Active
Individual
THOMPSON SIVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC157
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017011
REGENCE BLUE SHIELD
ID
01
—
Q4392
BLUE CROSS OF IDAHO
ID
Enumeration date
01/17/2007
Last updated
07/08/2007
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