Provider Demographics
NPI:1326260738
Name:THURSTON, JOAN ELAINE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELAINE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SILVER GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2475
Mailing Address - Country:US
Mailing Address - Phone:904-208-0208
Mailing Address - Fax:
Practice Address - Street 1:12443 SAN JOSE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8648
Practice Address - Country:US
Practice Address - Phone:904-208-0208
Practice Address - Fax:904-814-8876
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9903101YP2500X
FLMH 7885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional