Provider Demographics
NPI:1245395300
Name:THORN, ALEXANDRA LIES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:LIES
Last Name:THORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 5TH ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6651
Mailing Address - Country:US
Mailing Address - Phone:918-336-3626
Mailing Address - Fax:918-336-3626
Practice Address - Street 1:117 W 5TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6651
Practice Address - Country:US
Practice Address - Phone:918-336-3626
Practice Address - Fax:918-336-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical