Provider Demographics
NPI:1578892691
Name:HURST, JESSICA ANNETTE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNETTE
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNETTE
Other - Last Name:SIEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK ROAD
Mailing Address - Street 2:EXECUTIVE PLAZA 1 SUITE 800
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-800-2169
Mailing Address - Fax:410-777-8742
Practice Address - Street 1:11350 MCCORMICK ROAD
Practice Address - Street 2:EXECUTIVE PLAZA 1 SUITE 800
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:410-777-8742
Is Sole Proprietor?:No
Enumeration Date:2009-12-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional