MEDICARE: TREVOR HURLEY LMFT

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	106H00000X	Marriage & Family Therapist	137978	CA

General Provider Information

NPI Number	:	1942048574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR HURLEY LMFT

Provider Business Mailing Address
First Line	:	6825 SPRINGVIEW PL
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-4893
Country	:	US
Telephone Number	:	909-262-2556
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 SPRINGVIEW PL
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-4893
Country	:	US
Telephone Number	:	909-262-2556
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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