Provider Demographics
NPI:1528893922
Name:GARDENIA THORN THERAPEUTIC ALTERNATIVES, PLLC
Entity type:Organization
Organization Name:GARDENIA THORN THERAPEUTIC ALTERNATIVES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:DIONE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC-S
Authorized Official - Phone:409-893-1720
Mailing Address - Street 1:580 DEVON ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2050
Mailing Address - Country:US
Mailing Address - Phone:409-893-1720
Mailing Address - Fax:
Practice Address - Street 1:580 DEVON ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2050
Practice Address - Country:US
Practice Address - Phone:409-893-1720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty