Healthcare Provider Details

I. General information

NPI: 1063763845
Provider Name (Legal Business Name): KELLY RENNER HURLIMANN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY RENNER MOORE MFT

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 CENTURY BLVD NE SUITE B
ATLANTA GA
30345-3393
US

IV. Provider business mailing address

1762 CENTURY BLVD SUITE B
ATLANTA GA
30345-3393
US

V. Phone/Fax

Practice location:
  • Phone: 404-633-0250
  • Fax: 404-475-0331
Mailing address:
  • Phone: 404-633-0250
  • Fax: 404-475-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: