Provider Demographics
NPI:1073810685
Name:EVITT THORNE, JUDY (MC, EDD, LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:EVITT THORNE
Suffix:
Gender:F
Credentials:MC, EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 E BROADWAY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1511
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-921-8410
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1511
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-921-8410
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 12446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional