Individual
DR. SUSAN STICE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4206 GNARL DR, AUSTIN, TX 78731-2012
(512) 775-3669
Mailing address
4206 GNARL DR, AUSTIN, TX 78731-2012
(512) 775-3669
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G8444
TX
2084P0804X
Child & Adolescent Psychiatry Physician
G8444
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10739630
CAQH
—
01
—
G8444
TEXAS MEDICAL LICENSE
TX
Enumeration date
02/23/2018
Last updated
02/23/2018
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