Provider Demographics
NPI:1427361757
Name:THORNBURG, KARLA (LMSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:KAY
Other - Last Name:THORNBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-472-3142
Mailing Address - Fax:512-472-4008
Practice Address - Street 1:1717 W 10TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3907
Practice Address - Country:US
Practice Address - Phone:512-472-3142
Practice Address - Fax:512-472-4008
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker