Provider Demographics
NPI:1053587279
Name:THURMAN, TYLER D (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:D
Last Name:THURMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2328
Mailing Address - Country:US
Mailing Address - Phone:618-332-2083
Mailing Address - Fax:618-337-6039
Practice Address - Street 1:6000 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2328
Practice Address - Country:US
Practice Address - Phone:618-332-2083
Practice Address - Fax:618-337-6039
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional