Healthcare Provider Details

I. General information

NPI: 1881035301
Provider Name (Legal Business Name): KATHY LEE HURLEY PH.D, TH.D, BCBA-D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 SEMINOLA BLVD SUITE 116
CASSELBERRY FL
32701
US

IV. Provider business mailing address

650 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6862
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-9814
  • Fax: 407-775-5039
Mailing address:
  • Phone: 407-975-0400
  • Fax: 407-696-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-3219
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: