Healthcare Provider Details

I. General information

NPI: 1669531877
Provider Name (Legal Business Name): DAVID MARTIN HURLEY L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10522 S CICERO AVE STE 202
OAK LAWN IL
60453-5290
US

IV. Provider business mailing address

10522 S CICERO AVE STE 202
OAK LAWN IL
60453-5290
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-2211
  • Fax: 708-636-5552
Mailing address:
  • Phone: 708-636-2211
  • Fax: 708-636-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: