Provider Demographics
NPI:1750648523
Name:THURSTON, STEPHANIE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:THURSTON
Suffix:
Gender:F
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-1648
Mailing Address - Country:US
Mailing Address - Phone:805-444-8787
Mailing Address - Fax:
Practice Address - Street 1:107 FIGUEROA ST
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:805-444-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS224171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical