MEDICARE: HAILIE DURST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E.2607192	OH

General Provider Information

NPI Number	:	1104408350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILIE DURST

Provider Business Mailing Address
First Line	:	556 NILES CORTLAND RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2433
Country	:	US
Telephone Number	:	330-647-6207
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 NILES CORTLAND RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2433
Country	:	US
Telephone Number	:	330-647-6207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	06/05/2026

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Directions to “ HAILIE DURST ” Practice Location

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