Provider Demographics
NPI:1043605165
Name:THORNBURGH, ANDREW NICHOLAS (MA, BCBA, LBA, RBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:NICHOLAS
Last Name:THORNBURGH
Suffix:
Gender:
Credentials:MA, BCBA, LBA, RBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1114
Mailing Address - Country:US
Mailing Address - Phone:613-621-2316
Mailing Address - Fax:
Practice Address - Street 1:15209 8TH AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1114
Practice Address - Country:US
Practice Address - Phone:613-621-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61660534103K00000X
FL0-15-6479103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst