Healthcare Provider Details

I. General information

NPI: 1396474052
Provider Name (Legal Business Name): CASSANDRA JEAN HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 N PENNSYLVANIA ST
DENVER CO
80203-2502
US

IV. Provider business mailing address

1133 N PENNSYLVANIA ST
DENVER CO
80203-2502
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-0117
  • Fax:
Mailing address:
  • Phone: 303-551-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSW.000992306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: