Healthcare Provider Details

I. General information

NPI: 1861920589
Provider Name (Legal Business Name): JORDAN HURST BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7113 THREE CHOPT RD
RICHMOND VA
23226-3643
US

IV. Provider business mailing address

7113 THREE CHOPT RD
RICHMOND VA
23226-3643
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-9997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000955
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: