Provider Demographics
NPI:1205406758
Name:THORNLEY, LINDSAY N (MFTA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:N
Last Name:THORNLEY
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3321
Mailing Address - Country:US
Mailing Address - Phone:502-500-5861
Mailing Address - Fax:
Practice Address - Street 1:3321 RUCKRIEGEL PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3765
Practice Address - Country:US
Practice Address - Phone:502-500-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist