Provider Demographics
NPI:1871617571
Name:THORNBURG, KARIN ELLEEN (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:ELLEEN
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3952
Mailing Address - Country:US
Mailing Address - Phone:317-423-8909
Mailing Address - Fax:
Practice Address - Street 1:1033 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3952
Practice Address - Country:US
Practice Address - Phone:317-423-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000212A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health