Provider Demographics
NPI:1386941318
Name:HURLEY, CHRISTINE (MA, TLLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19953 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1334
Mailing Address - Country:US
Mailing Address - Phone:313-366-1115
Mailing Address - Fax:313-366-1116
Practice Address - Street 1:19953 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1334
Practice Address - Country:US
Practice Address - Phone:313-366-1115
Practice Address - Fax:313-366-1116
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1848116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist