Healthcare Provider Details

I. General information

NPI: 1235274788
Provider Name (Legal Business Name): JOSHUA LEE HURST BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 KLONDIKE RD
REPUBLIC WA
99166-9701
US

IV. Provider business mailing address

PO BOX 61
REPUBLIC WA
99166-0061
US

V. Phone/Fax

Practice location:
  • Phone: 509-775-3341
  • Fax: 509-775-8906
Mailing address:
  • Phone: 509-775-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00056108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: