1417015967 NPI number — DIDI K THURMAN LPC

Table of content: DIDI K THURMAN LPC (NPI 1417015967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417015967 NPI number — DIDI K THURMAN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURMAN
Provider First Name:
DIDI
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417015967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 AIRPORT RD
Provider Second Line Business Mailing Address:
PO BOX 747
Provider Business Mailing Address City Name:
TERRELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75160-4302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-524-4159
Provider Business Mailing Address Fax Number:
972-563-5321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 COLLEGE ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SULPHUR SPRINGS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75482-3466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-885-8611
Provider Business Practice Location Address Fax Number:
903-439-1080
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  16483 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84058L . This is a "PRIVATE INSURANCE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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