Provider Demographics
NPI:1497750996
Name:THORSON, KEVIN DONALD (M ED)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DONALD
Last Name:THORSON
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4506
Mailing Address - Country:US
Mailing Address - Phone:520-325-5196
Mailing Address - Fax:520-325-5197
Practice Address - Street 1:700 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4506
Practice Address - Country:US
Practice Address - Phone:520-325-5196
Practice Address - Fax:520-325-5197
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist