Healthcare Provider Details

I. General information

NPI: 1912536988
Provider Name (Legal Business Name): CHRISTOPHER HURD QMHP-BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E EAST END BLVD N
MARSHALL TX
75670
US

IV. Provider business mailing address

2006 BLEDSOE ST
MARSHALL TX
75670-5912
US

V. Phone/Fax

Practice location:
  • Phone: 903-471-5132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: