Provider Demographics
NPI:1114114774
Name:THURSTON, JOANNE LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LOUISE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9196 LAKE AVE S
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-8619
Mailing Address - Country:US
Mailing Address - Phone:320-231-5958
Mailing Address - Fax:
Practice Address - Street 1:9196 LAKE AVE S
Practice Address - Street 2:
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-8619
Practice Address - Country:US
Practice Address - Phone:320-231-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist