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General NPI Number Information
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NPI Number | 1295910602
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Entity Type | Individual
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Provider Name | THOMAS FLETCHER THORNTON LISW
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Gender | Male
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 1601-A ST. MICHAEL'S DR.
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City | SANTA FE
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State | NM
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Zip | 87505-1601
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Country | US
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Telephone | 509-429-1462
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2062
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City | LAS VEGAS
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State | NM
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Zip | 87701-2062
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Country | US
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Telephone | 505-429-1462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-1512
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License Number State | NM
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