MEDICARE: KRISTEN HURLEY PSYD

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	103TC0700X	Clinical Psychologist	20042922A	IN

General Provider Information

NPI Number	:	1417302209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN HURLEY PSYD

Provider Business Mailing Address
First Line	:	2675 FOX POINTE DR STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3391
Country	:	US
Telephone Number	:	812-376-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 FOX POINTE DR STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3391
Country	:	US
Telephone Number	:	812-376-0900
Fax Number	:

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	04/28/2016

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