| Doctor Name: | WESLEY CLIFFORD THOMPSON |
| NPI Number: | 1053714154 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 2014031972 |
| Business Practice Address: | 1432 Southwest Blvd Jefferson City, MO - 651092444 |
| Business Phone Number: | 5736325560 |
| Business Fax Number: | 5736325875 |
| Mailing Address: | 1432 Southwest Blvd, JEFFERSON CITY |
| State: | MO |
| Postal Code: | 651092444 |
| Phone Number: | 5736325560 |
| Fax Number: | 5736325875 |
| NPI Enumeration Date: | 10/02/2014 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2014031972 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |