Provider Demographics
NPI:1396470902
Name:HURTT, MARKLE (MARCO)
Entity type:Individual
Prefix:
First Name:MARKLE
Middle Name:
Last Name:HURTT
Suffix:
Gender:M
Credentials:MARCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MCKINLEY BLVD APT 1E
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1665
Mailing Address - Country:US
Mailing Address - Phone:812-262-4400
Mailing Address - Fax:
Practice Address - Street 1:6 MCKINLEY BLVD APT 1E
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-1665
Practice Address - Country:US
Practice Address - Phone:812-262-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN872594569103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service