Healthcare Provider Details

I. General information

NPI: 1225476294
Provider Name (Legal Business Name): JAMES MICHAEL HURLEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 WESTGATE MALL SUITE 200
CLEVELAND OH
44126-1323
US

IV. Provider business mailing address

16305 LARCHWOOD AVE
CLEVELAND OH
44135-1209
US

V. Phone/Fax

Practice location:
  • Phone: 440-333-4949
  • Fax:
Mailing address:
  • Phone: 216-337-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0600273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: