Provider Demographics
NPI:1609942929
Name:THOMPSON, J. GRAHAM (LMFT)
Entity type:Individual
Prefix:MR
First Name:J.
Middle Name:GRAHAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2312
Mailing Address - Country:US
Mailing Address - Phone:217-544-3143
Mailing Address - Fax:217-544-4436
Practice Address - Street 1:1020 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2312
Practice Address - Country:US
Practice Address - Phone:217-544-3143
Practice Address - Fax:217-544-4436
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL166-000115OtherMARRIAGE & FAMILY THERAPI