Provider Demographics
NPI:1326274192
Name:HURLEY, TARA MICHELLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MICHELLE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2107
Mailing Address - Country:US
Mailing Address - Phone:781-648-9728
Mailing Address - Fax:
Practice Address - Street 1:11 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2107
Practice Address - Country:US
Practice Address - Phone:781-648-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist