Provider Demographics
NPI:1831363878
Name:HURST, JANICE MARIE (LADAC)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MARIE
Last Name:HURST
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:225 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3832
Mailing Address - Country:US
Mailing Address - Phone:505-454-9611
Mailing Address - Fax:
Practice Address - Street 1:225 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3832
Practice Address - Country:US
Practice Address - Phone:505-454-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)