Provider Demographics
NPI:1942460639
Name:HURST, SANDRA (MBA LBSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:MBA LBSW
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 359
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746-0359
Mailing Address - Country:US
Mailing Address - Phone:989-871-6695
Mailing Address - Fax:989-871-3663
Practice Address - Street 1:8361 ELLIS RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-0359
Practice Address - Country:US
Practice Address - Phone:989-871-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802035102101YM0800X
MI68010351021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical