Healthcare Provider Details

I. General information

NPI: 1770919359
Provider Name (Legal Business Name): JENNIFER LAUREN HURLEY M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LAUREN RYCZKO M.A., LPC

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/11/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36400 WOODWARD AVE STE 202
BLOOMFIELD HILLS MI
48304-0913
US

IV. Provider business mailing address

3330 MERRILL AVE
ROYAL OAK MI
48073-6815
US

V. Phone/Fax

Practice location:
  • Phone: 248-895-3710
  • Fax:
Mailing address:
  • Phone: 248-895-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: