Healthcare Provider Details

I. General information

NPI: 1265743868
Provider Name (Legal Business Name): BRETT HURM PH.D., HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVERSMAN DR
JASPER IN
47546-3548
US

IV. Provider business mailing address

PO BOX 769
JASPER IN
47547-0769
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-3020
  • Fax:
Mailing address:
  • Phone: 812-482-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20042901A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: