Healthcare Provider Details

I. General information

NPI: 1851799985
Provider Name (Legal Business Name): CHAD THURSTON C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N 1680 E SUITE A
ST GEORGE UT
84790-2579
US

IV. Provider business mailing address

1680 EAST 230 NORTH SUITE A
ST. GEORGE UT
84790
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-4916
  • Fax:
Mailing address:
  • Phone: 435-703-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8686227-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8686227-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: