Healthcare Provider Details

I. General information

NPI: 1558942482
Provider Name (Legal Business Name): RICHARD OWEN HURT JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13260 N 94TH DR
PEORIA AZ
85381-4828
US

IV. Provider business mailing address

7144 E HORIZON DR
CAVE CREEK AZ
85331-8673
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-7763
  • Fax:
Mailing address:
  • Phone: 602-615-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-003431
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: