Healthcare Provider Details

I. General information

NPI: 1619015252
Provider Name (Legal Business Name): RIK S HURLESS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HAGGERTY LN SUITE 270
BOZEMAN MT
59715-8800
US

IV. Provider business mailing address

PO BOX 851
BOZEMAN MT
59771-0851
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-4145
  • Fax:
Mailing address:
  • Phone: 406-586-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 703
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: