Provider Demographics
NPI:1235403809
Name:JUDITH THURSWELL, PSYD, PLLC
Entity Type:Organization
Organization Name:JUDITH THURSWELL, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:THURSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-613-4443
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:248-562-7611
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:248-562-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014257103TC0700X
MI6401009511251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty