1285395251 NPI number — MARA ELIZABETH THORNBERG LPC, LCPC

Table of content: MARA ELIZABETH THORNBERG LPC, LCPC (NPI 1285395251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285395251 NPI number — MARA ELIZABETH THORNBERG LPC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNBERG
Provider First Name:
MARA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINEZ
Provider Other First Name:
MARAH
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285395251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 S MAIN ST STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-661-2895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 N. 1ST ST
Provider Second Line Business Practice Location Address:
STE 2 PBA 260
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59840-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-661-2895
Provider Business Practice Location Address Fax Number:
406-258-0551
Provider Enumeration Date:
01/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  83681 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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