Provider Demographics
NPI:1588822373
Name:THOR, MICHELLE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:THOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82958 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-7835
Mailing Address - Country:US
Mailing Address - Phone:402-841-0841
Mailing Address - Fax:
Practice Address - Street 1:82958 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:NE
Practice Address - Zip Code:68779-7835
Practice Address - Country:US
Practice Address - Phone:402-841-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3182101YM0800X
NE12241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health