Healthcare Provider Details

I. General information

NPI: 1477278927
Provider Name (Legal Business Name): HEATHER LYNN HURWITT MFT, MHC, & PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 NW 53RD AVE STE B
GAINESVILLE FL
32653-4812
US

IV. Provider business mailing address

4715 NW 53RD AVE STE B
GAINESVILLE FL
32653-4812
US

V. Phone/Fax

Practice location:
  • Phone: 813-928-9140
  • Fax:
Mailing address:
  • Phone: 813-928-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3707
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131414
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: