Provider Demographics
NPI:1528396462
Name:HURLEY, KATHLEEN MARIE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 PROSPECT AVE STE I
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6074
Mailing Address - Country:US
Mailing Address - Phone:314-690-1667
Mailing Address - Fax:314-677-3404
Practice Address - Street 1:140 PROSPECT AVE STE I
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6074
Practice Address - Country:US
Practice Address - Phone:314-690-1667
Practice Address - Fax:314-677-3404
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024366101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490038653Medicaid
MO81-1158886OtherTIN