Provider Demographics
NPI:1508092628
Name:THURMAN, VINCENT LENARD (PSYCHIATRIC ASSISTAN)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LENARD
Last Name:THURMAN
Suffix:
Gender:M
Credentials:PSYCHIATRIC ASSISTAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 ALEXANDER ST
Mailing Address - Street 2:#209
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4976
Mailing Address - Country:US
Mailing Address - Phone:808-255-8621
Mailing Address - Fax:
Practice Address - Street 1:1427 ALEXANDER STREET
Practice Address - Street 2:209
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-255-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst