Healthcare Provider Details

I. General information

NPI: 1184082927
Provider Name (Legal Business Name): DAVID SCOTT HURST LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N CAPITAL AVE
IDAHO FALLS ID
83402-3405
US

IV. Provider business mailing address

5484 S 45TH W
IDAHO FALLS ID
83402-5715
US

V. Phone/Fax

Practice location:
  • Phone: 208-552-0855
  • Fax: 208-523-1132
Mailing address:
  • Phone: 208-521-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5936
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: