Healthcare Provider Details

I. General information

NPI: 1427755826
Provider Name (Legal Business Name): VALERIE MEDINA HURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SAKELARES BLVD
GRANTS NM
87020-3819
US

IV. Provider business mailing address

21319 GANTON DR
KATY TX
77450-5229
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-1890
  • Fax:
Mailing address:
  • Phone: 703-674-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0107
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: