Healthcare Provider Details

I. General information

NPI: 1619983491
Provider Name (Legal Business Name): SHIRLEY J THURSTON MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NORTH COLLEGE AVENUE
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

9875 S VIEW DR
ROGERS AR
72756-8174
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-5065
  • Fax: 479-587-5994
Mailing address:
  • Phone: 479-621-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-982
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: