Healthcare Provider Details

I. General information

NPI: 1326867896
Provider Name (Legal Business Name): GABRIEL J HURTADO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E TRUMAN RD
KANSAS CITY MO
64106-3152
US

IV. Provider business mailing address

2307 MONITOR PL
KANSAS CITY MO
64108-2311
US

V. Phone/Fax

Practice location:
  • Phone: 913-521-4199
  • Fax:
Mailing address:
  • Phone: 816-905-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024032214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: