Provider Demographics
NPI:1033412812
Name:HURTADO, TYNE (LMHC, NCC, QS)
Entity Type:Individual
Prefix:
First Name:TYNE
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:LMHC, NCC, QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 LITTLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1715
Mailing Address - Country:US
Mailing Address - Phone:727-487-1185
Mailing Address - Fax:
Practice Address - Street 1:4109 LITTLE RD STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1715
Practice Address - Country:US
Practice Address - Phone:727-487-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009918500Medicaid