Healthcare Provider Details

I. General information

NPI: 1972654127
Provider Name (Legal Business Name): AMY BETH HURST MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOX DR
CHAMPAIGN IL
61820-7236
US

IV. Provider business mailing address

918 S LYNN ST
CHAMPAIGN IL
61820-6315
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-8080
  • Fax: 217-398-0172
Mailing address:
  • Phone: 217-398-8080
  • Fax: 217-398-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: