Provider Demographics
NPI:1346535333
Name:THORNTON, GREG (MED, LADC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MED, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2974 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2441
Mailing Address - Country:US
Mailing Address - Phone:775-397-5929
Mailing Address - Fax:
Practice Address - Street 1:100 YOUTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89803
Practice Address - Country:US
Practice Address - Phone:775-738-7182
Practice Address - Fax:775-738-8812
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV433-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)