MEDICARE: KIMBERLY K. THORN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT-10002	AZ

General Provider Information

NPI Number	:	1144461187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY K. THORN LMFT

Provider Business Mailing Address
First Line	:	7075 W BELL RD
Second Line	:	SUITE 3
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8546
Country	:	US
Telephone Number	:	866-327-6196
Fax Number	:	866-327-6196

Provider Business Practice Location Address
First Line	:	7075 W BELL RD
Second Line	:	SUITE 3
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8546
Country	:	US
Telephone Number	:	866-327-6196
Fax Number	:	866-327-6196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2009
Last Update Date	:	03/22/2009

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