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General NPI Number Information
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NPI Number | 1457772865
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Entity Type | Individual
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Provider Name | GRANT GORDON MARIUS THORNLEY M.A., L.M.F.T.A.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 14216 NE 21ST ST
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City | BELLEVUE
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State | WA
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Zip | 98007-3720
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Country | US
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Telephone | 425-653-4900
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Fax | 425-653-4910
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Provider Business Mailing Address
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Address Line | 1600 E OLIVE ST
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City | SEATTLE
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State | WA
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Zip | 98122-2735
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Country | US
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Telephone | 206-302-2200
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Fax | 206-302-2210
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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 | MG60560770
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License Number State | WA
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