Healthcare Provider Details

I. General information

NPI: 1750999868
Provider Name (Legal Business Name): KATHLEEN MICHELE HURLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E BROADWAY ST STE 331
BUTTE MT
59701-9305
US

IV. Provider business mailing address

409 S EXCELSIOR AVE
BUTTE MT
59701-2205
US

V. Phone/Fax

Practice location:
  • Phone: 406-282-4940
  • Fax:
Mailing address:
  • Phone: 319-491-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-40000
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-43915
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7650
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: