Healthcare Provider Details

I. General information

NPI: 1396752580
Provider Name (Legal Business Name): RITA HURT CLINICAL PSYCHOLOGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DOWLER RD STE B
BEAUMONT TX
77706
US

IV. Provider business mailing address

150 DOWLEN RD STE B
BEAUMONT TX
77706-6085
US

V. Phone/Fax

Practice location:
  • Phone: 409-866-5002
  • Fax: 409-866-1390
Mailing address:
  • Phone: 409-866-5002
  • Fax: 409-866-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: