Healthcare Provider Details

I. General information

NPI: 1154517845
Provider Name (Legal Business Name): MELISSA HURLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MCALISTER DR
ORMOND BEACH FL
32174-7040
US

IV. Provider business mailing address

73 MCALISTER DR
ORMOND BEACH FL
32174-7040
US

V. Phone/Fax

Practice location:
  • Phone: 386-333-2324
  • Fax:
Mailing address:
  • Phone: 386-333-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: