Healthcare Provider Details

I. General information

NPI: 1043490634
Provider Name (Legal Business Name): KEVIN DONALD HURLEY PSY.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 N 128TH DR
LITCHFIELD PARK AZ
85340-4116
US

IV. Provider business mailing address

5511 N 128TH DR
LITCHFIELD PARK AZ
85340-4116
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-1864
  • Fax:
Mailing address:
  • Phone: 623-850-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4158
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: