MEDICARE: HAILEY HURST

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	101YM0800X	Mental Health Counselor	LMFT160672	CA

General Provider Information

NPI Number	:	1780421578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY HURST

Provider Business Mailing Address
First Line	:	5101 SANTA MONICA BLVD STE 8
Second Line	:	PMB1112
City	:	LOS ANGELES
State	:	CA
Zip	:	90029
Country	:	US
Telephone Number	:	323-432-0491
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SANTA MONICA BLVD STE 8
Second Line	:	PMB1112
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2480
Country	:	US
Telephone Number	:	323-432-0491
Fax Number	:

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

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	04/07/2026

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Directions to “ HAILEY HURST ” Practice Location

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