Healthcare Provider Details

I. General information

NPI: 1194394841
Provider Name (Legal Business Name): KATHLEEN THURMOND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5479 E ABBEYFIELD ST STE 3
LONG BEACH CA
90815-3050
US

IV. Provider business mailing address

288 TEMPLE AVE
LONG BEACH CA
90803-5435
US

V. Phone/Fax

Practice location:
  • Phone: 562-879-1602
  • Fax:
Mailing address:
  • Phone: 562-879-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW12514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: