Healthcare Provider Details

I. General information

NPI: 1376658286
Provider Name (Legal Business Name): JOHN H. THURMAN JR. M.DIV., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OSUNA RD NE # H SUITE 4
ALBUQUERQUE NM
87107-5952
US

IV. Provider business mailing address

320 OSUNA RD NE # H SUITE 4
ALBUQUERQUE NM
87107-5952
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2778
  • Fax: 505-345-2878
Mailing address:
  • Phone: 505-345-2778
  • Fax: 505-345-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: