Provider Demographics
NPI:1558942482
Name:HURT, RICHARD OWEN JR (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:OWEN
Last Name:HURT
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7144 E HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-8673
Mailing Address - Country:US
Mailing Address - Phone:602-615-8035
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4828
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-003431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical