Provider Demographics
NPI:1144456088
Name:THOMPSON-DYSON, LISA J (MA, LCPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:THOMPSON-DYSON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13281 E CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-5017
Mailing Address - Country:US
Mailing Address - Phone:815-955-1016
Mailing Address - Fax:815-944-8256
Practice Address - Street 1:13043 E 2260S RD
Practice Address - Street 2:
Practice Address - City:MOMENCE
Practice Address - State:IL
Practice Address - Zip Code:60954-3696
Practice Address - Country:US
Practice Address - Phone:815-955-1016
Practice Address - Fax:815-944-8256
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional