Healthcare Provider Details

I. General information

NPI: 1578111886
Provider Name (Legal Business Name): STEPHANIE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 113TH AVE NE STE 210
KIRKLAND WA
98034-6950
US

IV. Provider business mailing address

7924 236TH ST SW APT 212
EDMONDS WA
98026-8837
US

V. Phone/Fax

Practice location:
  • Phone: 425-224-3784
  • Fax:
Mailing address:
  • Phone: 916-955-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60214683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: