Provider Demographics
NPI:1447635313
Name:THOMPSON, COLLEEN MARIE (LMFT 86224)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT 86224
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 325
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:CA
Mailing Address - Zip Code:96052-0325
Mailing Address - Country:US
Mailing Address - Phone:707-834-3437
Mailing Address - Fax:530-221-0267
Practice Address - Street 1:777 LOMA VISTA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3113
Practice Address - Country:US
Practice Address - Phone:530-221-5683
Practice Address - Fax:530-221-0267
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist