MEDICARE: MANDI M THORNTON B.S.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1760636260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDI M THORNTON B.S.

Provider Business Mailing Address
First Line	:	4436 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2212
Country	:	US
Telephone Number	:	405-427-7025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 NE 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-6818
Country	:	US
Telephone Number	:	405-427-1529
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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