Provider Demographics
NPI:1427213065
Name:HURST, CANDICE LARIZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:LARIZ
Last Name:HURST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12499 BRANTLEY COMMONS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5676
Mailing Address - Country:US
Mailing Address - Phone:239-278-3443
Mailing Address - Fax:239-278-3550
Practice Address - Street 1:12499 BRANTLEY COMMONS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5676
Practice Address - Country:US
Practice Address - Phone:239-278-3443
Practice Address - Fax:239-278-3550
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical