Healthcare Provider Details

I. General information

NPI: 1811708282
Provider Name (Legal Business Name): YANELY HURTADO CORE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W EMERALD ST STE C100
BOISE ID
83706-2058
US

IV. Provider business mailing address

1120 POWELL AVE
NAMPA ID
83687-6809
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-0160
  • Fax:
Mailing address:
  • Phone: 208-420-7049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8471747
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: