MEDICARE: DEBORAH SHANE THORNTON LPC

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	101YP2500X	Professional Counselor	68988	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68988	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR NUMBER

General Provider Information

NPI Number	:	1538533997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH SHANE THORNTON LPC

Provider Business Mailing Address
First Line	:	3509 HULEN ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6800
Country	:	US
Telephone Number	:	682-234-5298
Fax Number	:	817-810-9585

Provider Business Practice Location Address
First Line	:	3509 HULEN ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6800
Country	:	US
Telephone Number	:	682-234-5298
Fax Number	:	817-810-9585

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

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	12/24/2016

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