Provider Demographics
NPI:1871282988
Name:THOMPSON, MALIA
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 NE ROAD RUNNER DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-1147
Mailing Address - Country:US
Mailing Address - Phone:405-227-3101
Mailing Address - Fax:
Practice Address - Street 1:317 NE ROAD RUNNER DR
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OK
Practice Address - Zip Code:73541-1147
Practice Address - Country:US
Practice Address - Phone:405-227-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty