Individual
DR. DIANE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
415 ONATE ST, ESPANOLA, NM 87532
(505) 927-1727
Mailing address
1073 ENCANTADO DR, SANTA FE, NM 87501-1076
(505) 927-1727
(505) 984-2908
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
730
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM00JB65
BLUE CROSS BLUE SHIELD
NM
05
—
15571076
—
NM
01
—
NM100436
VALUE OPTIONS
NM
Enumeration date
10/05/2006
Last updated
07/09/2007
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