Provider Demographics
NPI:1831354711
Name:THORNE, MICHELE C (PHD, HSPP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:THORNE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 GLEBE ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7372
Mailing Address - Country:US
Mailing Address - Phone:317-779-2260
Mailing Address - Fax:
Practice Address - Street 1:2159 GLEBE ST STE 270
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7372
Practice Address - Country:US
Practice Address - Phone:317-779-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042258A103TC0700X
IN20042258103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN084940KMedicare PIN