Healthcare Provider Details

I. General information

NPI: 1982320636
Provider Name (Legal Business Name): MECHELE HURT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S RIVERSIDE PLZ STE 875
CHICAGO IL
60606-3717
US

IV. Provider business mailing address

10 S RIVERSIDE PLZ STE 875
CHICAGO IL
60606-3717
US

V. Phone/Fax

Practice location:
  • Phone: 312-474-6189
  • Fax:
Mailing address:
  • Phone: 312-474-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: