Provider Demographics
NPI:1134762198
Name:THURBER, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:THURBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4072
Mailing Address - Country:US
Mailing Address - Phone:480-433-1101
Mailing Address - Fax:
Practice Address - Street 1:100 CONGRESS AVE # 1034
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4072
Practice Address - Country:US
Practice Address - Phone:480-433-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician