Healthcare Provider Details

I. General information

NPI: 1316038425
Provider Name (Legal Business Name): CYNTHIA LOUISE HURLEY LISW-S, LICDC-CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 W SPRAGUE RD SUITE 225
CLEVELAND OH
44130-6318
US

IV. Provider business mailing address

16600 W SPRAGUE RD SUITE 225
CLEVELAND OH
44130-6318
US

V. Phone/Fax

Practice location:
  • Phone: 440-821-6556
  • Fax:
Mailing address:
  • Phone: 440-821-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number021003
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 0007443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: