MEDICARE: MR. KEVIN DONALD THORSON M. ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0031	AZ

General Provider Information

NPI Number	:	1497750996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN DONALD THORSON M. ED.

Provider Business Mailing Address
First Line	:	700 N COUNTRY CLUB RD
Second Line	:	SUITE 120
City	:	TUCSON
State	:	AZ
Zip	:	85716-4506
Country	:	US
Telephone Number	:	520-325-5196
Fax Number	:	520-325-5197

Provider Business Practice Location Address
First Line	:	700 N COUNTRY CLUB RD
Second Line	:	SUITE 120
City	:	TUCSON
State	:	AZ
Zip	:	85716-4506
Country	:	US
Telephone Number	:	520-325-5196
Fax Number	:	520-325-5197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	05/02/2008

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