Provider Demographics
NPI:1336359629
Name:THORSON, MARTHA HOLLAND (DMIN, MA)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HOLLAND
Last Name:THORSON
Suffix:
Gender:F
Credentials:DMIN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5332
Mailing Address - Country:US
Mailing Address - Phone:951-259-8573
Mailing Address - Fax:951-766-4574
Practice Address - Street 1:51 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5243
Practice Address - Country:US
Practice Address - Phone:909-793-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65386106H00000X
CA12051101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral