Provider Demographics
NPI:1285982751
Name:HURD, CAROL LYNN (BSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:HURD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W CHURCHILL WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-2163
Mailing Address - Country:US
Mailing Address - Phone:501-563-8336
Mailing Address - Fax:
Practice Address - Street 1:1201 W CHURCHILL WAY
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-2163
Practice Address - Country:US
Practice Address - Phone:501-563-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)