Provider Demographics
NPI:1871850461
Name:THOMPSON NEUROFEEDBACK
Entity type:Organization
Organization Name:THOMPSON NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:210-593-8774
Mailing Address - Street 1:4230 GARDENDALE ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3475
Mailing Address - Country:US
Mailing Address - Phone:210-593-8774
Mailing Address - Fax:210-593-9714
Practice Address - Street 1:4230 GARDENDALE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3475
Practice Address - Country:US
Practice Address - Phone:210-593-8774
Practice Address - Fax:210-593-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty