Healthcare Provider Details

I. General information

NPI: 1174372551
Provider Name (Legal Business Name): ALEXANDRA HURLEY MA, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLY HURLEY

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CASA WAY
SAN FRANCISCO CA
94123-1206
US

IV. Provider business mailing address

57 CASA WAY
SAN FRANCISCO CA
94123-1206
US

V. Phone/Fax

Practice location:
  • Phone: 650-787-1031
  • Fax:
Mailing address:
  • Phone: 650-787-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61519287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: