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General NPI Number Information
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NPI Number | 1336359629
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Entity Type | Individual
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Provider Name | MARTHA HOLLAND THORSON D.MIN., M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 51 W OLIVE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-5243
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Country | US
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Telephone | 909-793-1078
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Fax |
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Provider Business Mailing Address
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Address Line | 965 LEXINGTON ST
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City | HEMET
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State | CA
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Zip | 92545-5332
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Country | US
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Telephone | 951-259-8573
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Fax | 951-766-4574
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 65386
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 12051
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License Number State | CA
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