Provider Demographics
NPI:1982767679
Name:HURICH, JAMIE S (PPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:S
Last Name:HURICH
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 OVERDALE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718
Mailing Address - Country:US
Mailing Address - Phone:307-688-5000
Mailing Address - Fax:307-688-5015
Practice Address - Street 1:501 S. BURMA AVENUE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82717-3011
Practice Address - Country:US
Practice Address - Phone:307-688-5000
Practice Address - Fax:307-688-5015
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC 304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional