Provider Demographics
NPI:1386651982
Name:HURLEY, JAMES TILDEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TILDEN
Last Name:HURLEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 S TOWNE SQ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7830
Mailing Address - Country:US
Mailing Address - Phone:314-845-1550
Mailing Address - Fax:314-845-1550
Practice Address - Street 1:11140 S TOWNE SQ
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7830
Practice Address - Country:US
Practice Address - Phone:314-845-1550
Practice Address - Fax:314-845-1550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00878103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent