Provider Demographics
NPI:1922526623
Name:THORNHILL, GREGORY SCOTT
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MAIN ST UNIT 112
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-7004
Mailing Address - Country:US
Mailing Address - Phone:810-458-4718
Mailing Address - Fax:
Practice Address - Street 1:126 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8623
Practice Address - Country:US
Practice Address - Phone:810-333-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6361007922103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator