MEDICARE: THORNHILL COUNSELING, LLC

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

General Provider Information

NPI Number	:	1841757481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORNHILL COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 77017
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 LINCOLN AVE # 200
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-4972
Country	:	US
Telephone Number	:	970-879-7637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRAIG RANDALL THORNHILL
Credential	:	LPC, LAC
Telephone Number	:	970-879-7637

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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