Provider Demographics
NPI:1417302209
Name:HURLEY, KRISTEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HURLEY
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 1:2675 FOX POINTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3391
Mailing Address - Country:US
Mailing Address - Phone:812-376-0900
Mailing Address - Fax:
Practice Address - Street 1:2675 FOX POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3391
Practice Address - Country:US
Practice Address - Phone:812-376-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042922A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical