Provider Demographics
NPI:1346330743
Name:HOOVER, KURT LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:LEE
Last Name:HOOVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 EHRLICH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2006
Mailing Address - Country:US
Mailing Address - Phone:813-926-3170
Mailing Address - Fax:
Practice Address - Street 1:5221 EHRLICH RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2006
Practice Address - Country:US
Practice Address - Phone:813-926-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4918103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59627Medicare ID - Type UnspecifiedPROVIDER NUMBER
FLR16891Medicare UPIN