Healthcare Provider Details

I. General information

NPI: 1417518010
Provider Name (Legal Business Name): REBECCA BROOKE HURLEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 KY 3439
BARBOURVILLE KY
40906-7201
US

IV. Provider business mailing address

PO BOX 550
BARBOURVILLE KY
40906-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-3805
  • Fax:
Mailing address:
  • Phone: 606-546-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number252283
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: