Healthcare Provider Details

I. General information

NPI: 1205533403
Provider Name (Legal Business Name): MARY ELLEN HURLEY MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6084 OLOHENA RD
KAPAA HI
96746-8701
US

IV. Provider business mailing address

6084 OLOHENA RD
KAPAA HI
96746-8701
US

V. Phone/Fax

Practice location:
  • Phone: 808-639-6089
  • Fax:
Mailing address:
  • Phone: 808-639-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number889
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: