Provider Demographics
NPI:1760905319
Name:THORN, JOSHUA KIRK (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KIRK
Last Name:THORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-5202
Mailing Address - Country:US
Mailing Address - Phone:801-426-8800
Mailing Address - Fax:801-426-8825
Practice Address - Street 1:870 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5202
Practice Address - Country:US
Practice Address - Phone:801-426-8800
Practice Address - Fax:801-426-8825
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5079967-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20-0849476OtherORGANIZATION: TELOS