Provider Demographics
NPI:1568478741
Name:THORN, KIRK B (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:B
Last Name:THORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 DRAPER PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9044
Mailing Address - Country:US
Mailing Address - Phone:801-676-0333
Mailing Address - Fax:801-676-0336
Practice Address - Street 1:1111 DRAPER PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9044
Practice Address - Country:US
Practice Address - Phone:801-676-0333
Practice Address - Fax:801-676-0336
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116358-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical