Provider Demographics
NPI:1528077633
Name:HURLEY, EDWARD LEE (LMFT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:HURLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 STONEGATE CT # 832
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4802
Mailing Address - Country:US
Mailing Address - Phone:601-527-3100
Mailing Address - Fax:601-693-7910
Practice Address - Street 1:832 STONEGATE CT # 832
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4802
Practice Address - Country:US
Practice Address - Phone:601-527-3100
Practice Address - Fax:601-693-7910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-0079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist