Provider Demographics
NPI:1376834440
Name:THURMAN, DEBRA L (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:THURMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:KAIROS YOUTH SERVICES
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3066
Mailing Address - Country:US
Mailing Address - Phone:406-727-0076
Mailing Address - Fax:406-452-8382
Practice Address - Street 1:625 CENTRAL AVE W
Practice Address - Street 2:SUITE #205
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-2874
Practice Address - Country:US
Practice Address - Phone:406-727-0076
Practice Address - Fax:406-452-8382
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1005-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070788OtherBLUE CROSS-SHIELD OF MONTANA
MT0000070788OtherBLUE CROSS-SHIELD OF MONTANA