Healthcare Provider Details

I. General information

NPI: 1568124972
Provider Name (Legal Business Name): LAUREN ELAINE HURD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6478
US

IV. Provider business mailing address

1808 RED LANE EXT
SALEM VA
24153-1733
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax:
Mailing address:
  • Phone: 330-696-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007589
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: