Healthcare Provider Details

I. General information

NPI: 1568734036
Provider Name (Legal Business Name): JACKELINE HURTADO M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MAPLERIDGE ST SUITE 106
HOUSTON TX
77081-4600
US

IV. Provider business mailing address

PO BOX 66308
HOUSTON TX
77266-6308
US

V. Phone/Fax

Practice location:
  • Phone: 713-351-7360
  • Fax:
Mailing address:
  • Phone: 832-548-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: