=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104049261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA M. THORNTON MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 08/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26520 GRAND RIVER AVE. SUITE 107
-----------------------------------------------------
City | REDFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-537-7230
-----------------------------------------------------
Fax | 313-537-1866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20125 HARBOR LN
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-537-7230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401008086
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------