Provider Demographics
NPI:1043367261
Name:THOMPSON, LAILA E (MA LMHC)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14211
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98511-4211
Mailing Address - Country:US
Mailing Address - Phone:360-790-9378
Mailing Address - Fax:360-790-9378
Practice Address - Street 1:1000 KRESKY AVE
Practice Address - Street 2:#6
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3700
Practice Address - Country:US
Practice Address - Phone:360-790-9378
Practice Address - Fax:360-790-9378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health