Healthcare Provider Details

I. General information

NPI: 1366672891
Provider Name (Legal Business Name): ELISHA C. HURLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 12/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 LOWES DR W
CLARKSVILLE TN
37040-6888
US

IV. Provider business mailing address

PO BOX 31298
CLARKSVILLE TN
37040-0022
US

V. Phone/Fax

Practice location:
  • Phone: 931-553-6981
  • Fax: 931-553-6982
Mailing address:
  • Phone: 931-553-6981
  • Fax: 931-553-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101
License Number StateTN

VIII. Authorized Official

Name: ELISHA C. HURLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: DMIN, PHD, LMFT
Phone: 931-553-6981