Provider Demographics
NPI:1821549189
Name:THORNTON, KIMBERLY (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 103RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423
Mailing Address - Country:US
Mailing Address - Phone:806-445-2009
Mailing Address - Fax:
Practice Address - Street 1:3805 22ND ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1142
Practice Address - Country:US
Practice Address - Phone:806-445-2009
Practice Address - Fax:806-702-8169
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70898101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor