Healthcare Provider Details

I. General information

NPI: 1811689151
Provider Name (Legal Business Name): RAPHAELLA HURD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N BROOM ST FL 2
MADISON WI
53703-5207
US

IV. Provider business mailing address

301 N BROOM ST FL 2
MADISON WI
53703-5207
US

V. Phone/Fax

Practice location:
  • Phone: 608-301-5708
  • Fax: 608-729-3434
Mailing address:
  • Phone: 608-301-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number832-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: