Healthcare Provider Details

I. General information

NPI: 1235403809
Provider Name (Legal Business Name): JUDITH THURSWELL, PSYD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD 177
WEST BLOOMFIELD MI
48322-2267
US

IV. Provider business mailing address

5777 W MAPLE RD 177
WEST BLOOMFIELD MI
48322-2267
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-4443
  • Fax: 248-562-7611
Mailing address:
  • Phone: 248-613-4443
  • Fax: 248-562-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014257
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6401009511
License Number StateMI

VIII. Authorized Official

Name: DR. JUDITH LINDA THURSWELL
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 248-613-4443