Provider Demographics
NPI:1053575084
Name:THOMPSON, JAMES DALE (LMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DALE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-1723
Mailing Address - Country:US
Mailing Address - Phone:941-730-3411
Mailing Address - Fax:941-755-4755
Practice Address - Street 1:10308 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-1723
Practice Address - Country:US
Practice Address - Phone:941-730-3411
Practice Address - Fax:941-755-4755
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health