Healthcare Provider Details

I. General information

NPI: 1346028214
Provider Name (Legal Business Name): JASON MICHAEL HURD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N PARKER ST
OLATHE KS
66061-2438
US

IV. Provider business mailing address

PO BOX 19114
LENEXA KS
66285-9114
US

V. Phone/Fax

Practice location:
  • Phone: 913-523-6081
  • Fax: 913-392-7199
Mailing address:
  • Phone: 913-523-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11238
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11238
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: