Healthcare Provider Details

I. General information

NPI: 1659587137
Provider Name (Legal Business Name): JAMES BASSETT HURLEY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 CLINTON BLVD
JACKSON MS
39209-3004
US

IV. Provider business mailing address

310 SE LINDA DR
CLINTON MS
39056-3152
US

V. Phone/Fax

Practice location:
  • Phone: 601-923-1630
  • Fax:
Mailing address:
  • Phone: 601-924-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0221
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: