Provider Demographics
NPI:1972760361
Name:HURLEY, PATRICK JAMES (MA,NCSP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:HURLEY
Suffix:
Gender:M
Credentials:MA,NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 DUTCH RIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:NEW STRAITSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43766-9712
Mailing Address - Country:US
Mailing Address - Phone:740-342-4206
Mailing Address - Fax:
Practice Address - Street 1:3245 DUTCH RIDGE RD SE
Practice Address - Street 2:
Practice Address - City:NEW STRAITSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43766-9712
Practice Address - Country:US
Practice Address - Phone:740-342-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0553584Medicaid