Healthcare Provider Details

I. General information

NPI: 1457823148
Provider Name (Legal Business Name): AMANDA MARIE HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CHENEY ST
RENO NV
89502-0912
US

IV. Provider business mailing address

231 MORAN ST APT B
RENO NV
89501-2314
US

V. Phone/Fax

Practice location:
  • Phone: 775-525-1616
  • Fax:
Mailing address:
  • Phone: 775-501-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: