Healthcare Provider Details

I. General information

NPI: 1659537975
Provider Name (Legal Business Name): ANDREW LAIRD HURLEY L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 W 12TH ST
LAUREL MS
39440-2515
US

IV. Provider business mailing address

2033 W 12TH ST
LAUREL MS
39440-2515
US

V. Phone/Fax

Practice location:
  • Phone: 601-668-8699
  • Fax:
Mailing address:
  • Phone: 601-668-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1127
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: