Provider Demographics
NPI:1114328457
Name:HURT, SHARON BROOKE (LPC, ACADC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BROOKE
Last Name:HURT
Suffix:
Gender:F
Credentials:LPC, ACADC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:BROOKE
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-0124
Mailing Address - Country:US
Mailing Address - Phone:208-269-1134
Mailing Address - Fax:866-387-2237
Practice Address - Street 1:420 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1324
Practice Address - Country:US
Practice Address - Phone:208-269-1134
Practice Address - Fax:866-387-2237
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YA0400X
IDLPC-5756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)