Provider Demographics
NPI:1639436165
Name:HURST, TAMARA MCCAULEY (PHD, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MCCAULEY
Last Name:HURST
Suffix:
Gender:F
Credentials:PHD, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MIST LAKE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1063
Mailing Address - Country:US
Mailing Address - Phone:502-229-3378
Mailing Address - Fax:859-788-3915
Practice Address - Street 1:3201 MIST LAKE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1063
Practice Address - Country:US
Practice Address - Phone:502-229-3378
Practice Address - Fax:859-788-3915
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100424920Medicaid