Healthcare Provider Details

I. General information

NPI: 1619460821
Provider Name (Legal Business Name): CHRISTINA HURTADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 MANCHACA RD
AUSTIN TX
78745-3633
US

IV. Provider business mailing address

1221 W BEN WHITE BLVD STE 210A
AUSTIN TX
78704-7182
US

V. Phone/Fax

Practice location:
  • Phone: 512-960-4533
  • Fax: 512-887-3970
Mailing address:
  • Phone: 512-960-4533
  • Fax: 512-887-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number55765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: