Healthcare Provider Details

I. General information

NPI: 1508875113
Provider Name (Legal Business Name): JANE CHIYO THORNTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BARBARA LOOP SE SUITE I
RIO RANCHO NM
87124-1088
US

IV. Provider business mailing address

1400 BARBARA LOOP SE SUITE I
RIO RANCHO NM
87124-1088
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-3279
  • Fax:
Mailing address:
  • Phone: 505-250-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0116071
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: