Provider Demographics
NPI:1194916429
Name:THORSON, CARLYLE HANS (MSW)
Entity type:Individual
Prefix:
First Name:CARLYLE
Middle Name:HANS
Last Name:THORSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:PETE
Other - Middle Name:CARLYLE
Other - Last Name:THORSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-479-5901
Mailing Address - Fax:
Practice Address - Street 1:715 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5500
Practice Address - Country:US
Practice Address - Phone:541-479-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health