Provider Demographics
NPI:1598120008
Name:HURLBUTT, ALYSON (MFT)
Entity Type:Individual
Prefix:MS
First Name:ALYSON
Middle Name:
Last Name:HURLBUTT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:CAY
Other - Last Name:HURLBUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4405 W RIVERSIDE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4050
Mailing Address - Country:US
Mailing Address - Phone:323-744-0741
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR STE 207
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:323-744-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist