MEDICARE: MS. KENDRA MICHELLE THORINGTON-FOX LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	6401011827	MI

General Provider Information

NPI Number	:	1033485370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDRA MICHELLE THORINGTON-FOX LPC

Provider Business Mailing Address
First Line	:	14200 W 8 MILE RD UNIT 47526
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-7765
Country	:	US
Telephone Number	:	248-629-9169
Fax Number	:	248-250-5392

Provider Business Practice Location Address
First Line	:	24500 FORD RD STE 3
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3145
Country	:	US
Telephone Number	:	248-629-9169
Fax Number	:	248-250-5392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	12/06/2019

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