Provider Demographics
NPI:1518087998
Name:HURRELL, MARK LAWRENCE (MFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LAWRENCE
Last Name:HURRELL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3970
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3970
Mailing Address - Country:US
Mailing Address - Phone:310-920-1452
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE 304A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:310-920-1452
Practice Address - Fax:310-831-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist