Provider Demographics
NPI:1518977487
Name:THOR, CLAUDETTE (LCDC)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:THOR
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-3101
Mailing Address - Country:US
Mailing Address - Phone:512-893-0721
Mailing Address - Fax:
Practice Address - Street 1:711 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-384-5446
Practice Address - Fax:719-384-5672
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13938101YA0400X
OKCERT. #9673101Y00000X
OK560101YA0400X
OK3722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor