Healthcare Provider Details

I. General information

NPI: 1336157379
Provider Name (Legal Business Name): SUSAN I HURST PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TOM BELL RD STE C
MURPHYS CA
95247-9585
US

IV. Provider business mailing address

636 EDGEWOOD LOOP
ANGELS CAMP CA
95222-8212
US

V. Phone/Fax

Practice location:
  • Phone: 714-993-1664
  • Fax: 714-993-1079
Mailing address:
  • Phone: 209-990-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC19508
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: