Provider Demographics
NPI:1962877621
Name:THORNTON, MICHELLE LEE (MSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WINONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-2206
Mailing Address - Country:US
Mailing Address - Phone:405-482-7208
Mailing Address - Fax:
Practice Address - Street 1:15514 E COUNTY ROAD 1585
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker