Provider Demographics
NPI:1588098370
Name:STEPHANIE THURSTON, LCSW, A PROFESSIONAL PSYCHOTHERAPY CORP
Entity type:Organization
Organization Name:STEPHANIE THURSTON, LCSW, A PROFESSIONAL PSYCHOTHERAPY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-444-8787
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-1648
Mailing Address - Country:US
Mailing Address - Phone:805-444-8787
Mailing Address - Fax:
Practice Address - Street 1:107 FIGUEROA ST
Practice Address - Street 2:UNIT A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:805-444-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty