Active NPI
Jacob D. Thornton, MHC-LIMITED PERMIT
- Mental Health Counselor
- East Elmhurst, NY
National Provider Identifier
1063980068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P10428
- Practice address
- 2626 75TH St
East Elmhurst, NY 11370-1427 - Phone
- (347) 448-4770
- Fax
- (718) 350-3072
- NPI assigned
- Nov 7, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P10428 | NY | Primary |
Addresses
Primary practice location
2626 75TH St
East Elmhurst, NY 11370-1427
Mailing address
2626 75TH St
East Elmhurst, NY 11370-1427
Phone (347) 448-4770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10428 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541548800000",
"number": "1063980068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2626 75TH ST",
"city": "EAST ELMHURST",
"state": "NY",
"postal_code": "113701427",
"telephone_number": "347-448-4770",
"fax_number": "718-350-3072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2626 75TH ST",
"city": "EAST ELMHURST",
"state": "NY",
"postal_code": "113701427",
"telephone_number": "347-448-4770",
"fax_number": "718-350-3072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORNTON",
"first_name": "JACOB",
"middle_name": "D.",
"credential": "MHC-LIMITED PERMIT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-07",
"last_updated": "2018-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P10428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.