Individual
WILLSON S THORNTON
Active
Individual
WILLSON S THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
23579
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R54M
MEDICARE
TX
01
—
23579
STATE LICENSE
TX
Enumeration date
08/10/2006
Last updated
03/19/2013
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