Healthcare Provider Details

I. General information

NPI: 1619036803
Provider Name (Legal Business Name): STEVEN DAVID THURBER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH STREET SE WOODLAND CENTERS
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

249 23RD ST SE
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-9148
  • Fax: 320-231-9140
Mailing address:
  • Phone: 320-235-4613
  • Fax: 320-231-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4451
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: