Provider Demographics
NPI:1790554434
Name:HURLBURT, AMY L (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HURLBURT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 TROPHY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5482
Mailing Address - Country:US
Mailing Address - Phone:817-876-7048
Mailing Address - Fax:
Practice Address - Street 1:532 SILICON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9018
Practice Address - Country:US
Practice Address - Phone:817-755-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty