Provider Demographics
NPI:1225145162
Name:THURSWELL, JUDITH LINDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LINDA
Last Name:THURSWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 W MAPLE RD
Mailing Address - Street 2:177
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2267
Mailing Address - Country:US
Mailing Address - Phone:248-613-4443
Mailing Address - Fax:
Practice Address - Street 1:5777 W MAPLE RD
Practice Address - Street 2:177
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2267
Practice Address - Country:US
Practice Address - Phone:248-613-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical