Healthcare Provider Details

I. General information

NPI: 1992124499
Provider Name (Legal Business Name): MICHELLE K HURTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COTTMAN AVE
PHILADELPHIA PA
19111
US

IV. Provider business mailing address

150 N. RADNOR CHESTER ROAD SUITE F200 #879
RADNOR PA
19087
US

V. Phone/Fax

Practice location:
  • Phone: 610-984-1090
  • Fax:
Mailing address:
  • Phone: 610-984-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC011885
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: