Provider Demographics
NPI:1184428161
Name:HURD, CALVIN
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:HURD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 JENNIE LEE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6159
Mailing Address - Country:US
Mailing Address - Phone:208-974-5200
Mailing Address - Fax:
Practice Address - Street 1:1904 JENNIE LEE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6159
Practice Address - Country:US
Practice Address - Phone:208-974-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8071464104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker