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General NPI Number Information
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NPI Number | 1326260738
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Entity Type | Individual
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Provider Name | JOAN ELAINE THURSTON LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 12443 SAN JOSE BLVD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8648
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Country | US
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Telephone | 904-208-0208
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Fax | 904-814-8876
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Provider Business Mailing Address
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Address Line | 312 SILVER GLEN AVE
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-2475
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Country | US
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Telephone | 904-208-0208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC9903
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 7885
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License Number State | FL
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