Provider Demographics
NPI:1467654947
Name:THURMAN, PAUL ROBERT (LMHC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROBERT
Last Name:THURMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HAMMOND RD
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3415
Mailing Address - Country:US
Mailing Address - Phone:516-659-7828
Mailing Address - Fax:
Practice Address - Street 1:17 HAMMOND RD
Practice Address - Street 2:UPSTAIRS
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3415
Practice Address - Country:US
Practice Address - Phone:516-659-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004032OtherMENTAL HEALTH COUNSELOR