Provider Demographics
NPI:1285184325
Name:THORNTON, MONICA LEE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 S LEWIS AVE
Mailing Address - Street 2:SUITE # 180
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1044
Mailing Address - Country:US
Mailing Address - Phone:918-960-7852
Mailing Address - Fax:539-664-5738
Practice Address - Street 1:6216 S LEWIS AVE
Practice Address - Street 2:SUITE # 180
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1044
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor