Provider Demographics
NPI:1962914549
Name:HURLEY, TIMOTHY P (MAC, PLMHP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:HURLEY
Suffix:
Gender:M
Credentials:MAC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 VIKING RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2249
Mailing Address - Country:US
Mailing Address - Phone:402-910-2636
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST STE 420
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5468
Practice Address - Country:US
Practice Address - Phone:402-910-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11055OtherPROVISIONAL LICENSED MENTAL HEALTH PRACTITIONER