Provider Demographics
NPI:1972820116
Name:HURLEY, KAMA (LCPC)
Entity Type:Individual
Prefix:
First Name:KAMA
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KAMA
Other - Middle Name:
Other - Last Name:HINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:2463 E ASHBROOK CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6612
Mailing Address - Country:US
Mailing Address - Phone:208-565-2623
Mailing Address - Fax:
Practice Address - Street 1:1243 E IRON EAGLE DR STE 130
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6599
Practice Address - Country:US
Practice Address - Phone:208-565-2623
Practice Address - Fax:208-502-2581
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4480101Y00000X
IDLCPC-5254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor