Provider Demographics
NPI:1609510387
Name:THURMAN, VERONICA KELLY (MA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:KELLY
Last Name:THURMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 PONDEROSA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4049
Mailing Address - Country:US
Mailing Address - Phone:909-238-3604
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE J206
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7921
Practice Address - Country:US
Practice Address - Phone:949-436-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107385OtherCINGA