Healthcare Provider Details

I. General information

NPI: 1760008205
Provider Name (Legal Business Name): KATHLEEN HURST LPC-MHSP (TEMP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 GALLATIN AVE STE 100
NASHVILLE TN
37206-3237
US

IV. Provider business mailing address

5305B MICHIGAN AVE
NASHVILLE TN
37209-2047
US

V. Phone/Fax

Practice location:
  • Phone: 615-429-6168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4908
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: