Healthcare Provider Details

I. General information

NPI: 1710342043
Provider Name (Legal Business Name): KERSTIN P HURLEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL SUITE 300
SIERRA VISTA AZ
85635-2900
US

IV. Provider business mailing address

155 CALLE PORTAL SUITE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-3011
  • Fax: 520-458-4467
Mailing address:
  • Phone: 520-459-3012
  • Fax: 520-515-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: