Provider Demographics
NPI:1528219839
Name:THORNTON, WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 ROGERS AVE
Mailing Address - Street 2:STE 535
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2047
Mailing Address - Country:US
Mailing Address - Phone:479-629-3737
Mailing Address - Fax:
Practice Address - Street 1:5111 ROGERS AVE
Practice Address - Street 2:STE 535
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-452-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08-21P103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent