1275220196 NPI number — JOSEPH THOMAS HURLBURT MS, LPC-IT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275220196 NPI number — JOSEPH THOMAS HURLBURT MS, LPC-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURLBURT
Provider First Name:
JOSEPH
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC-IT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275220196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-432-5966
Provider Business Mailing Address Fax Number:
920-432-5966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 APPLETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENASHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54952-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-739-4226
Provider Business Practice Location Address Fax Number:
920-432-5966
Provider Enumeration Date:
04/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 7323 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com