Healthcare Provider Details

I. General information

NPI: 1376253229
Provider Name (Legal Business Name): TIMOTHY SCOTT THORNBERRY JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 CHAMBERLIN AVE
FRANKFORT KY
40601-4288
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax: 216-456-8128
Mailing address:
  • Phone: 216-468-5000
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number161575
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: