Provider Demographics
NPI:1902082290
Name:THOMPSON, JERRY MIZELL (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:MIZELL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NW 33RD CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2582
Mailing Address - Country:US
Mailing Address - Phone:352-376-3559
Mailing Address - Fax:
Practice Address - Street 1:24 NW 33RD CT
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2582
Practice Address - Country:US
Practice Address - Phone:352-376-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000758MHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health