Provider Demographics
NPI:1457985186
Name:HURLBURT, MELISSA JEAN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:HURLBURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 KAYWIN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1735
Mailing Address - Country:US
Mailing Address - Phone:717-586-7986
Mailing Address - Fax:
Practice Address - Street 1:226 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3676
Practice Address - Country:US
Practice Address - Phone:610-258-1300
Practice Address - Fax:610-258-1301
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional