Provider Demographics
NPI:1770264046
Name:THORNTON, AMANDA COLLEEN (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:COLLEEN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-3215
Mailing Address - Country:US
Mailing Address - Phone:903-480-0101
Mailing Address - Fax:
Practice Address - Street 1:215 MARGARET ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-3215
Practice Address - Country:US
Practice Address - Phone:903-480-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional