Healthcare Provider Details

I. General information

NPI: 1215054937
Provider Name (Legal Business Name): KAREN CRONIAN HURLEY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN MARIE HURLEY MFT

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 12TH ST
MODESTO CA
95354-0838
US

IV. Provider business mailing address

3454 DYER CT
MODESTO CA
95350-1528
US

V. Phone/Fax

Practice location:
  • Phone: 209-765-2029
  • Fax:
Mailing address:
  • Phone: 209-765-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC18805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: