Provider Demographics
NPI:1508875113
Name:THORNTON, JANE CHIYO (LPCC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CHIYO
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BARBARA LOOP SE
Mailing Address - Street 2:SUITE I
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1088
Mailing Address - Country:US
Mailing Address - Phone:505-250-3279
Mailing Address - Fax:
Practice Address - Street 1:1400 BARBARA LOOP SE
Practice Address - Street 2:SUITE I
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1088
Practice Address - Country:US
Practice Address - Phone:505-250-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0116071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16631889Medicaid