MEDICARE: MS. ELIZABETH THORN LPC-MH LMFT

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	101Y00000X	Counselor	LPC-MH2097	SD
2	101YP2500X	Professional Counselor	LPC-MH2097	SD
3	106H00000X	Marriage & Family Therapist	LMFT1072	SD
4	101YM0800X	Mental Health Counselor	LPC-MH2097	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679514244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH THORN LPC-MH LMFT

Provider Business Mailing Address
First Line	:	1301 WEST OMAHA ST
Second Line	:	SUITE 220
City	:	RAPID CITY
State	:	SD
Zip	:	57701
Country	:	US
Telephone Number	:	605-716-9944
Fax Number	:	605-718-0413

Provider Business Practice Location Address
First Line	:	1301 WEST OMAHA ST
Second Line	:	SUITE 220
City	:	RAPID CITY
State	:	SD
Zip	:	57701
Country	:	US
Telephone Number	:	605-716-9944
Fax Number	:	605-718-0413

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/12/2021

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