Healthcare Provider Details

I. General information

NPI: 1932287190
Provider Name (Legal Business Name): JOHN MARTIN HURST LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 POLAR LN STE 101
CEDAR PARK TX
78613-3065
US

IV. Provider business mailing address

3000 POLAR LN STE 101
CEDAR PARK TX
78613-3065
US

V. Phone/Fax

Practice location:
  • Phone: 844-824-8775
  • Fax:
Mailing address:
  • Phone: 844-824-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18421
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: