Healthcare Provider Details

I. General information

NPI: 1144885971
Provider Name (Legal Business Name): GAELYN MARIE HURD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W HILL ST
DECATUR GA
30030-4367
US

IV. Provider business mailing address

170 BOULEVARD SE APT H403
ATLANTA GA
30312-2391
US

V. Phone/Fax

Practice location:
  • Phone: 404-213-4776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC006450
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013243
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: