Provider Demographics
NPI:1508075201
Name:THUR, JOHN R (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:THUR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-9160
Mailing Address - Country:US
Mailing Address - Phone:715-845-4900
Mailing Address - Fax:715-845-4970
Practice Address - Street 1:2600 STEWART AVE
Practice Address - Street 2:STE 38
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4148
Practice Address - Country:US
Practice Address - Phone:715-845-4900
Practice Address - Fax:715-845-4970
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI376-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39575900Medicaid