Provider Demographics
NPI:1306296355
Name:THURSTON, CHRISTINE R (MS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:THURSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 DEL TORMEY PL SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1841
Mailing Address - Country:US
Mailing Address - Phone:603-828-2600
Mailing Address - Fax:
Practice Address - Street 1:5224 DEL TORMEY PL SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1841
Practice Address - Country:US
Practice Address - Phone:603-828-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF86149101YM0800X
WAMG60664383106H00000X
WALF61134197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF61134197OtherLMFT