Provider Demographics
NPI:1184234395
Name:THORNHILL, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1304
Mailing Address - Country:US
Mailing Address - Phone:636-544-6102
Mailing Address - Fax:
Practice Address - Street 1:5498 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8020
Practice Address - Country:US
Practice Address - Phone:636-299-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017037458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health