Provider Demographics
NPI:1740563261
Name:THURMAN, MYESHA RENEE (BA, RSST)
Entity Type:Individual
Prefix:MRS
First Name:MYESHA
Middle Name:RENEE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:BA, RSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26180 W. OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146
Mailing Address - Country:US
Mailing Address - Phone:248-632-0472
Mailing Address - Fax:
Practice Address - Street 1:26180 W. OUTER DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146
Practice Address - Country:US
Practice Address - Phone:248-632-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker