| Doctor Name: | MR. KEVIN LEE THOMPSON |
| NPI Number: | 1417015413 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 6302 13th Street Lucerne, CA - 954588106 |
| Business Phone Number: | 7079947090 |
| Business Fax Number: | 7079947096 |
| Mailing Address: | Po Box 3371, CLEARLAKE |
| State: | CA |
| Postal Code: | 954223371 |
| Phone Number: | 7073505536 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |