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General NPI Number Information
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NPI Number | 1508075201
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Entity Type | Individual
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Provider Name | JOHN R. THUR LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 2600 STEWART AVE STE 38
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City | WAUSAU
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State | WI
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Zip | 54401-4148
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Country | US
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Telephone | 715-845-4900
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Fax | 715-845-4970
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Provider Business Mailing Address
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Address Line | 6623 COUNTY ROAD K
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City | AMHERST
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State | WI
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Zip | 54406-9160
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Country | US
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Telephone | 715-845-4900
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Fax | 715-845-4970
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 376-123
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License Number State | WI
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