Provider Demographics
NPI:1043396328
Name:THURMAN, CECILIA JS
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:JS
Last Name:THURMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3265
Mailing Address - Country:US
Mailing Address - Phone:253-445-8120
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:2120 WASHINGTON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:703-228-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2019-08-19
Deactivation Date:2019-03-27
Deactivation Code:
Reactivation Date:2019-06-06
Provider Licenses
StateLicense IDTaxonomies
WARC00055447101Y00000X
VA0701008188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor