Provider Demographics
NPI:1851799985
Name:THURSTON, CHAD (CSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:THURSTON
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 EAST 230 NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-703-4916
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E
Practice Address - Street 2:SUITE A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2579
Practice Address - Country:US
Practice Address - Phone:435-703-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8686227-35011041C0700X
UT8686227-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical