MEDICARE: MR. JUSTIN THETFORD MS, LPC-ASSOCIATE

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	101YM0800X	Mental Health Counselor	90610	TX

General Provider Information

NPI Number	:	1982549382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN THETFORD MS, LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	3112 33RD ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-3220
Country	:	US
Telephone Number	:	806-416-8467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 33RD ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-3220
Country	:	US
Telephone Number	:	806-416-8467
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ MR. JUSTIN THETFORD MS, LPC-ASSOCIATE” Practice Location

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