Provider Demographics
NPI:1871652214
Name:THORN, BECKY (MFT)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:
Last Name:THORN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 ORLENA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-1847
Mailing Address - Country:US
Mailing Address - Phone:562-426-7259
Mailing Address - Fax:562-597-2800
Practice Address - Street 1:4647 LONG BEACH BLVD STE A4
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6977
Practice Address - Country:US
Practice Address - Phone:562-426-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 12410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist