Provider Demographics
NPI:1881636355
Name:HURSEY, KARL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:G
Last Name:HURSEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 ZIMMERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-3730
Mailing Address - Country:US
Mailing Address - Phone:724-949-0058
Mailing Address - Fax:
Practice Address - Street 1:2595 INTERSTATE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9378
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:866-510-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV584103TH0100X
PAPS015698103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164662000Medicaid
276844OtherVALUEOPTIONS PROV NUM
276844OtherVALUEOPTIONS PROV NUM