Provider Demographics
NPI:1700131976
Name:THOMPSON, VIVIAN KAY
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:KAY
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 1:5520 LANGDON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-7148
Mailing Address - Country:US
Mailing Address - Phone:972-925-2980
Mailing Address - Fax:972-925-2981
Practice Address - Street 1:5520 LANGDON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-7148
Practice Address - Country:US
Practice Address - Phone:972-925-2980
Practice Address - Fax:972-925-2981
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
TX9388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional