Basic Information
| Provider Information | |||||||||
| NPI: | 1043396328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THURMAN | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | J.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E PIONEER | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983723265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534458120 | ||||||||
| FaxNumber: | 2536973730 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 WASHINGTON BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222045718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032284897 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2006 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/27/2019 | ||||||||
| NPIReactivationDate: | 06/06/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RC00055447 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 0701008188 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.