Healthcare Provider Details

I. General information

NPI: 1417121914
Provider Name (Legal Business Name): CHRISTINE HURST L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 07/13/2023
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 1ST AVE W
KALISPELL MT
59901-4836
US

IV. Provider business mailing address

428 1ST AVE W
KALISPELL MT
59901-4836
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-8689
  • Fax: 406-303-4039
Mailing address:
  • Phone: 406-219-8689
  • Fax: 406-303-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3143
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: