Provider Demographics
NPI:1275698250
Name:HURLEY, THOMAS JOHN (MFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:HURLEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KELLER ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2802
Mailing Address - Country:US
Mailing Address - Phone:707-763-7817
Mailing Address - Fax:
Practice Address - Street 1:1330 N DUTTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4646
Practice Address - Country:US
Practice Address - Phone:707-526-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 3275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist