Provider Demographics
NPI:1194004507
Name:THORN, BEVERLY ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ELAINE
Last Name:THORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HACKBERRY LANE GORDON PALMER HL RM 348
Mailing Address - Street 2:DEPT. OF PSYCHOLOGY, THE UNIVERSITY OF ALABAMA
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0348
Mailing Address - Country:US
Mailing Address - Phone:205-348-5024
Mailing Address - Fax:205-348-8648
Practice Address - Street 1:505 HACKBERRY LANE GORDON PALMER HL RM 348
Practice Address - Street 2:DEPT. OF PSYCHOLOGY, THE UNIVERSITY OF ALABAMA
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0348
Practice Address - Country:US
Practice Address - Phone:205-348-5024
Practice Address - Fax:205-348-8648
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical