Individual
WILLSON S THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
7777 FOREST LN, C-833, DALLAS, TX 75230-2505
(972) 566-6609
(972) 566-6679
Mailing address
7777 FOREST LN, C-833, DALLAS, TX 75230-2505
(972) 566-6609
(972) 566-6679
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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