Healthcare Provider Details

I. General information

NPI: 1821240649
Provider Name (Legal Business Name): CAROL E HURLY ED.D,LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9728 W. ESCUDA DR.
PEORIA AZ
85382-0950
US

IV. Provider business mailing address

6 RISING SUN CT LN
SALMON ID
83467
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-0191
  • Fax:
Mailing address:
  • Phone: 406-240-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1095
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009128
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number222
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#3587
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: