Healthcare Provider Details

I. General information

NPI: 1003344284
Provider Name (Legal Business Name): JANE ELIZABETH THORNTON LH 613075778
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NEZ PERCE DR
MOUNT VERNON WA
98273-9100
US

IV. Provider business mailing address

925 NEZ PERCE DR
MOUNT VERNON WA
98273-9100
US

V. Phone/Fax

Practice location:
  • Phone: 206-498-2387
  • Fax:
Mailing address:
  • Phone: 206-498-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61307578
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: