Individual provider Active NPI

Dominique Laurae Thurston

  • Marriage & Family Therapist
  • Philadelphia, PA
National Provider Identifier
1972395994
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MF001724 Issued in PA
Practice address
5939 Woodcrest Ave
Philadelphia, PA 19131-2216
Phone
(215) 873-3399
NPI assigned
May 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MF001724 PA Primary

Addresses

Primary practice location

5939 Woodcrest Ave
Philadelphia, PA 19131-2216

Mailing address

5939 Woodcrest Ave
Philadelphia, PA 19131-2216
Phone (215) 873-3399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250616003279 PA Practitioner - Marriage and Family Therapist 3678084795 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Marriage & Family Therapist CurrentSince May 22, 2025 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

1626 Locust St
Philadelphia, PA 19103
Phone (215) 709-3177

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1972395994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5939 WOODCREST AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191312216",
            "telephone_number": "215-873-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5939 WOODCREST AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191312216",
            "telephone_number": "215-873-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THURSTON",
        "first_name": "DOMINIQUE",
        "middle_name": "LAURAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-19",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "PA",
            "license": "MF001724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.