Provider Demographics
NPI:1396752580
Name:HURT, RITA (CLINICAL PSYCHOLOGIS)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:CLINICAL PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DOWLEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6085
Mailing Address - Country:US
Mailing Address - Phone:409-866-5002
Mailing Address - Fax:409-866-1390
Practice Address - Street 1:150 DOWLER RD
Practice Address - Street 2:STE B
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-866-5002
Practice Address - Fax:409-866-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34832103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149885901Medicaid