Healthcare Provider Details

I. General information

NPI: 1467772590
Provider Name (Legal Business Name): CHERYL HURST PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 12/31/2023
Certification Date: 12/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MICHIGAN AVE STE 607
CHICAGO IL
60605-1452
US

IV. Provider business mailing address

130 S CANAL ST APT 819
CHICAGO IL
60606-3918
US

V. Phone/Fax

Practice location:
  • Phone: 312-315-5557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: