Provider Demographics
NPI:1144461187
Name:THORN, KIMBERLY K (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:THORN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:THORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:7075 W BELL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8546
Mailing Address - Country:US
Mailing Address - Phone:866-327-6196
Mailing Address - Fax:866-327-6196
Practice Address - Street 1:7075 W BELL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8546
Practice Address - Country:US
Practice Address - Phone:866-327-6196
Practice Address - Fax:866-327-6196
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist