Provider Demographics
NPI:1114074036
Name:THOBURN, LINDEN (CSW)
Entity Type:Individual
Prefix:
First Name:LINDEN
Middle Name:
Last Name:THOBURN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GREEN CT
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1566
Mailing Address - Country:US
Mailing Address - Phone:734-222-6046
Mailing Address - Fax:734-222-3639
Practice Address - Street 1:3520 GREEN CT
Practice Address - Street 2:SUITE 185
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1566
Practice Address - Country:US
Practice Address - Phone:734-222-6046
Practice Address - Fax:734-222-3639
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILT0703461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N92560Medicare ID - Type Unspecified