1629406418 NPI number — MRS. BETTY JANE THORNTON ROUNDS LCSW

Table of content: MRS. BETTY JANE THORNTON ROUNDS LCSW (NPI 1629406418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629406418 NPI number — MRS. BETTY JANE THORNTON ROUNDS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON ROUNDS
Provider First Name:
BETTY
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROUNDS
Provider Other First Name:
BETTY
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629406418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1642 MCCULLOCH BLVD N
Provider Second Line Business Mailing Address:
#185
Provider Business Mailing Address City Name:
LAKE HAVASU CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86403-0961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-208-3613
Provider Business Mailing Address Fax Number:
928-854-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1979 MCCULLOCH BLVD N
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-0953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-208-3613
Provider Business Practice Location Address Fax Number:
928-854-1661
Provider Enumeration Date:
10/15/2013

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: 1041C0700X , with the licence number:  LCSW-13991 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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