Healthcare Provider Details

I. General information

NPI: 1669519062
Provider Name (Legal Business Name): KRISTIN A. HURLEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SAINT JOHN ST SUITE 232
PORTLAND ME
04102-3041
US

IV. Provider business mailing address

PO BOX 8735
PORTLAND ME
04104-8735
US

V. Phone/Fax

Practice location:
  • Phone: 207-650-8101
  • Fax:
Mailing address:
  • Phone: 207-650-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC2217
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: