Healthcare Provider Details

I. General information

NPI: 1376652941
Provider Name (Legal Business Name): THURMOND KIRKLAND LPC, LMSW, QMRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR ST
PORT HURON MI
48060-3838
US

IV. Provider business mailing address

230 HURON AVE
PORT HURON MI
48060-3822
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-4202
  • Fax:
Mailing address:
  • Phone: 810-966-4471
  • Fax: 810-985-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801034906
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401005446
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401005446
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: