Healthcare Provider Details

I. General information

NPI: 1043474620
Provider Name (Legal Business Name): DWIGHT DAVID HURST CPCI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 N HIGHWAY 89 STE 220
FARMINGTON UT
84025-2738
US

IV. Provider business mailing address

1466 N HIGHWAY 89 STE 220
FARMINGTON UT
84025-2738
US

V. Phone/Fax

Practice location:
  • Phone: 801-451-0475
  • Fax:
Mailing address:
  • Phone: 801-451-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number49631336009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: