Provider Demographics
NPI:1336893932
Name:HURLEY, SHANE PATRICK (LP MHC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:PATRICK
Last Name:HURLEY
Suffix:
Gender:M
Credentials:LP MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W SUNNYSIDE WAY APT 223
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1495
Mailing Address - Country:US
Mailing Address - Phone:585-435-7080
Mailing Address - Fax:
Practice Address - Street 1:636 PLANK RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2046
Practice Address - Country:US
Practice Address - Phone:518-545-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health