Healthcare Provider Details

I. General information

NPI: 1528309184
Provider Name (Legal Business Name): CRYSTAL MARIE HURTEAU LMSW, QMRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 E COURT ST SUITE F
FLINT MI
48506-4054
US

IV. Provider business mailing address

816 E 3RD ST
FLINT MI
48503-2013
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-6081
  • Fax: 810-232-6510
Mailing address:
  • Phone: 810-342-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: