Healthcare Provider Details

I. General information

NPI: 1750791141
Provider Name (Legal Business Name): DEBBRA HURT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 IRVIN RD
BIENVILLE LA
71008-2818
US

IV. Provider business mailing address

160 IRVIN RD
BIENVILLE LA
71008-2818
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-1056
  • Fax:
Mailing address:
  • Phone: 318-243-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9385
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: