Provider Demographics
NPI:1780400069
Name:THURMOND, HOSIE III (MA)
Entity type:Individual
Prefix:
First Name:HOSIE
Middle Name:
Last Name:THURMOND
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14843 ENERGY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5757
Mailing Address - Country:US
Mailing Address - Phone:952-209-1644
Mailing Address - Fax:952-423-0365
Practice Address - Street 1:14843 ENERGY WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5757
Practice Address - Country:US
Practice Address - Phone:952-209-1644
Practice Address - Fax:952-423-0365
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty