Active NPI
Clarence Alley Thompson III, M.F.C.C.
- Mental Health Counselor
- Venice, CA
National Provider Identifier
1508282385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFC 28772
- Practice address
- 225 4TH Ave
#203
Venice, CA 90291-8605 - Phone
- (310) 396-1716
- NPI assigned
- Mar 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFC 28772 | MA | Primary |
Addresses
Primary practice location
225 4TH Ave
#203
Venice, CA 90291-8605
Mailing address
225 4TH Ave
#203
Venice, CA 90291-8605
Phone (310) 396-1716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MFC 28772 | Other | CA | COBRA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC 28772 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395014400000",
"number": "1508282385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 4TH AVE",
"address_2": "#203",
"city": "VENICE",
"state": "CA",
"postal_code": "902918605",
"telephone_number": "310-396-1716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 4TH AVE",
"address_2": "#203",
"city": "VENICE",
"state": "CA",
"postal_code": "902918605",
"telephone_number": "310-396-1716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "CLARENCE",
"middle_name": "ALLEY",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "M.F.C.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-17",
"last_updated": "2014-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "MFC 28772",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COBRA",
"identifier": "MFC 28772",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Venice, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.