Provider Demographics
NPI:1598481079
Name:THOMAS - HURT, KIMBERLY LATRICE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LATRICE
Last Name:THOMAS - HURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4030
Mailing Address - Country:US
Mailing Address - Phone:216-255-1894
Mailing Address - Fax:
Practice Address - Street 1:14305 WHEELER RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4030
Practice Address - Country:US
Practice Address - Phone:216-255-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker