Provider Demographics
NPI:1598501702
Name:THORNTON, JOHN ASHLEY (LPC-A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ASHLEY
Last Name:THORNTON
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S HULEN ST # 124-155
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1929
Mailing Address - Country:US
Mailing Address - Phone:817-301-9851
Mailing Address - Fax:
Practice Address - Street 1:604 E 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4074
Practice Address - Country:US
Practice Address - Phone:817-301-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health