Provider Demographics
NPI:1093849465
Name:THORNTON, SUSAN LOUISE (MA,LP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LOUISE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2419
Mailing Address - Country:US
Mailing Address - Phone:612-332-7743
Mailing Address - Fax:612-332-7212
Practice Address - Street 1:1200 MARQUETTE AVE S
Practice Address - Street 2:WESTMINSTER COUNSELING CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2419
Practice Address - Country:US
Practice Address - Phone:612-332-7743
Practice Address - Fax:612-332-7212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AAPC FELLOW #4044101YP1600X
MN3857103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy