Healthcare Provider Details

I. General information

NPI: 1083361661
Provider Name (Legal Business Name): TYRREIA S HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 W PEORIA AVE STE 1
PEORIA AZ
85345-6317
US

IV. Provider business mailing address

9210 W PEORIA AVE STE 1
PEORIA AZ
85345-6317
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-3066
  • Fax: 480-718-7714
Mailing address:
  • Phone: 623-251-3066
  • Fax: 480-718-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: