Healthcare Provider Details

I. General information

NPI: 1881636355
Provider Name (Legal Business Name): KARL G. HURSEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 INTERSTATE DR SUITE 103
HARRISBURG PA
17110-9378
US

IV. Provider business mailing address

199 ZIMMERMAN RD
WAYNESBURG PA
15370-3730
US

V. Phone/Fax

Practice location:
  • Phone: 800-370-3651
  • Fax: 866-510-0020
Mailing address:
  • Phone: 724-949-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number584
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS015698
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS015698
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: