Healthcare Provider Details

I. General information

NPI: 1164907473
Provider Name (Legal Business Name): FAITH DANETTE HURLEY M.S., TLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 S WATER AVE STE E
GALLATIN TN
37066-6312
US

IV. Provider business mailing address

120 CINEMA DR APT 2211
HENDERSONVILLE TN
37075-6365
US

V. Phone/Fax

Practice location:
  • Phone: 615-527-3060
  • Fax:
Mailing address:
  • Phone: 615-579-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTLPC4123
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: