Healthcare Provider Details

I. General information

NPI: 1285935338
Provider Name (Legal Business Name): AMANDA HURLEY MA, LPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA PANDO

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N MULFORD RD
ROCKFORD IL
61107-3877
US

IV. Provider business mailing address

4100 VETERANS PKWY
MCHENRY IL
60050-8350
US

V. Phone/Fax

Practice location:
  • Phone: 815-363-6132
  • Fax:
Mailing address:
  • Phone: 815-363-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.007179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: