Provider Demographics
NPI:1669532982
Name:HURD, GWEN M (LCSW)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:M
Last Name:HURD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N BLUFF ST
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4566
Mailing Address - Country:US
Mailing Address - Phone:435-669-8375
Mailing Address - Fax:
Practice Address - Street 1:225 N BLUFF ST
Practice Address - Street 2:SUITE # 5
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4566
Practice Address - Country:US
Practice Address - Phone:435-669-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003764A1041C0700X
UT7027534-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical