Provider Demographics
NPI:1013149178
Name:THURMAN PSYCHOLOGICAL LLC
Entity Type:Organization
Organization Name:THURMAN PSYCHOLOGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES-THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-715-4321
Mailing Address - Street 1:6790 GROVER ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3642
Mailing Address - Country:US
Mailing Address - Phone:402-715-4321
Mailing Address - Fax:402-715-4343
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:SUITE #406
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9079
Practice Address - Country:US
Practice Address - Phone:402-715-4321
Practice Address - Fax:402-715-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00799261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0531582Medicaid
IAIB1338Medicare PIN