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General NPI Number Information
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NPI Number | 1306270996
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Entity Type | Individual
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Provider Name | JESSICA LAUREL THORNTON MA, LPC, NCC, EMDR-T
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Gender | Female
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 121 SIMPSON ST
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City | MORGANTOWN
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State | WV
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Zip | 26501-5921
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Country | US
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Telephone | 304-997-1796
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Fax | 877-471-0537
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Provider Business Mailing Address
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Address Line | 409 MADIGAN AVE
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City | MORGANTOWN
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State | WV
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Zip | 26501-6426
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Country | US
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Telephone | 304-997-1796
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC0007030
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2107
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License Number State | WV
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