Provider Demographics
NPI:1174645824
Name:THORNTON, SAMUEL G III (MA, NCSP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:G
Last Name:THORNTON
Suffix:III
Gender:M
Credentials:MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7071 W HILLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5255
Mailing Address - Country:US
Mailing Address - Phone:623-376-3971
Mailing Address - Fax:623-376-3980
Practice Address - Street 1:7071 W HILLCREST BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5255
Practice Address - Country:US
Practice Address - Phone:623-376-3971
Practice Address - Fax:623-376-3980
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool