Healthcare Provider Details

I. General information

NPI: 1417302209
Provider Name (Legal Business Name): KRISTEN HURLEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 FOX POINTE DR STE A
COLUMBUS IN
47203-3391
US

IV. Provider business mailing address

2675 FOX POINTE DR STE A
COLUMBUS IN
47203-3391
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-0900
  • Fax:
Mailing address:
  • Phone: 812-376-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042922A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: