Healthcare Provider Details

I. General information

NPI: 1437934239
Provider Name (Legal Business Name): MS. ASHLEY HURSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

IV. Provider business mailing address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-4890
  • Fax:
Mailing address:
  • Phone: 805-439-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: