Healthcare Provider Details

I. General information

NPI: 1316925217
Provider Name (Legal Business Name): BRIDGET HURT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N MAIN ST
POPLAR BLUFF MO
63901-4300
US

IV. Provider business mailing address

907 N MAIN ST
POPLAR BLUFF MO
63901-4300
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-6236
  • Fax: 573-776-6236
Mailing address:
  • Phone: 573-776-6236
  • Fax: 573-776-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2000159806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: