Healthcare Provider Details

I. General information

NPI: 1144599309
Provider Name (Legal Business Name): DAVID HURTADO JR. LPC LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2011
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18109 BELINDA DR
SMITHVILLE MO
64089-3701
US

IV. Provider business mailing address

18109 BELINDA DR
SMITHVILLE MO
64089-3701
US

V. Phone/Fax

Practice location:
  • Phone: 816-582-7785
  • Fax:
Mailing address:
  • Phone: 816-582-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2494
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011030020
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: