Provider Demographics
NPI:1952876187
Name:THORNBURGH, DUSTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:THORNBURGH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WINDFELLOW PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3075
Mailing Address - Country:US
Mailing Address - Phone:310-621-2120
Mailing Address - Fax:
Practice Address - Street 1:23 WINDFELLOW PL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-3075
Practice Address - Country:US
Practice Address - Phone:310-621-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2438103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst