Healthcare Provider Details

I. General information

NPI: 1063052926
Provider Name (Legal Business Name): DE'JA M HURTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E JOSEPHINE ST
SAN ANTONIO TX
78208-1027
US

IV. Provider business mailing address

6800 PARK TEN BLVD STE 200S
SAN ANTONIO TX
78213-4293
US

V. Phone/Fax

Practice location:
  • Phone: 210-261-3800
  • Fax: 210-261-1807
Mailing address:
  • Phone: 210-261-1060
  • Fax: 210-261-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: