Provider Demographics
NPI:1285842013
Name:THORNBRUGH, ED
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:THORNBRUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 BURGUNDY PL
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1223
Mailing Address - Country:US
Mailing Address - Phone:509-786-4196
Mailing Address - Fax:
Practice Address - Street 1:1031 BURGUNDY PL
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1223
Practice Address - Country:US
Practice Address - Phone:509-786-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health