Provider Demographics
NPI:1891121125
Name:HURT, ALETA LYNN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:ALETA
Middle Name:LYNN
Last Name:HURT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8244
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-8244
Mailing Address - Country:US
Mailing Address - Phone:574-931-2680
Mailing Address - Fax:574-246-1634
Practice Address - Street 1:6910 N MAIN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9681
Practice Address - Country:US
Practice Address - Phone:574-931-2680
Practice Address - Fax:574-931-2679
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002706A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health