Healthcare Provider Details

I. General information

NPI: 1295957041
Provider Name (Legal Business Name): PAULETTE MARY HURST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/23/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11434 B AVENUE
AUBURN CA
95603
US

IV. Provider business mailing address

11434 B AVENUE
AUBURN CA
95603
US

V. Phone/Fax

Practice location:
  • Phone: 530-718-4382
  • Fax:
Mailing address:
  • Phone: 530-718-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: