Provider Demographics
NPI:1376909739
Name:HURD, NATALIE (PSYD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:HURD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 W DARIEN WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2166
Mailing Address - Country:US
Mailing Address - Phone:623-772-5207
Mailing Address - Fax:
Practice Address - Street 1:325 S WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6869
Practice Address - Country:US
Practice Address - Phone:623-772-5207
Practice Address - Fax:623-772-5220
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4570103T00000X
AZ3869529103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool