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General NPI Number Information
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NPI Number | 1619983491
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Entity Type | Individual
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Provider Name | SHIRLEY J THURSTON MSW,LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1100 NORTH COLLEGE AVENUE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-444-5065
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Fax | 479-587-5994
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Provider Business Mailing Address
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Address Line | 9875 S VIEW DR
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City | ROGERS
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State | AR
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Zip | 72756-8174
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Country | US
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Telephone | 479-621-5032
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-982
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License Number State | AR
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