Provider Demographics
NPI:1588989602
Name:SHURLEY, AMY M
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:SHURLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:15818 SW WARFIELD BOULEVARD
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-0458
Mailing Address - Country:US
Mailing Address - Phone:772-597-0411
Mailing Address - Fax:772-597-0412
Practice Address - Street 1:15818 SW WARFIELD BLVD
Practice Address - Street 2:15818 SW WARFIELD BOULEVARD
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-3513
Practice Address - Country:US
Practice Address - Phone:772-597-0411
Practice Address - Fax:772-597-0412
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor