Provider Demographics
NPI:1821240649
Name:HURLY, CAROL E (EDD,LCPC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:HURLY
Suffix:
Gender:F
Credentials:EDD,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RISING SUN CT LN
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467
Mailing Address - Country:US
Mailing Address - Phone:406-240-0191
Mailing Address - Fax:
Practice Address - Street 1:9728 W. ESCUDA DR.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0950
Practice Address - Country:US
Practice Address - Phone:406-240-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1095101YA0400X
WALH00009128101YM0800X
MT222101YP2500X
ID#3587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ14279432OtherCAQH