Healthcare Provider Details

I. General information

NPI: 1518977487
Provider Name (Legal Business Name): CLAUDETTE THOR LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BARNES AVE
LA JUNTA CO
81050-2138
US

IV. Provider business mailing address

109 HICKORY LN
ELGIN TX
78621-3101
US

V. Phone/Fax

Practice location:
  • Phone: 719-384-5446
  • Fax: 719-384-5672
Mailing address:
  • Phone: 512-893-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13938
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: