Healthcare Provider Details

I. General information

NPI: 1467785592
Provider Name (Legal Business Name): MORGAN LYNNETTE HURST PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD PALLISTER PLACE
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD PALLISTER PLACE
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2523
  • Fax:
Mailing address:
  • Phone: 313-916-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014739
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301014739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: