Provider Demographics
NPI:1194927566
Name:THORNTON, MELANIE PATRYCE (LPC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:PATRYCE
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 1:307 E SEVIER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3934
Mailing Address - Country:US
Mailing Address - Phone:501-315-4224
Mailing Address - Fax:501-776-0411
Practice Address - Street 1:307 E SEVIER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3934
Practice Address - Country:US
Practice Address - Phone:501-315-4224
Practice Address - Fax:501-776-0411
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9412030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional