Provider Demographics
NPI:1043490634
Name:HURLEY, KEVIN DONALD (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DONALD
Last Name:HURLEY
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 N 128TH DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4116
Mailing Address - Country:US
Mailing Address - Phone:623-850-1864
Mailing Address - Fax:
Practice Address - Street 1:5511 N 128TH DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4116
Practice Address - Country:US
Practice Address - Phone:623-850-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical