1457383556 NPI number — DR. AUSTIN GOLLMER HURST PH.D., M.A.

Table of content: DR. AUSTIN GOLLMER HURST PH.D., M.A. (NPI 1457383556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457383556 NPI number — DR. AUSTIN GOLLMER HURST PH.D., M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURST
Provider First Name:
AUSTIN
Provider Middle Name:
GOLLMER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NONE
Provider Other First Name:
NONE
Provider Other Middle Name:
NONE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457383556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
954 RISA RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94549-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-284-0691
Provider Business Mailing Address Fax Number:
925-283-2381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
954 RISA RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94549-3418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-284-0691
Provider Business Practice Location Address Fax Number:
925-283-2381
Provider Enumeration Date:
07/07/2006

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: 103TC0700X , with the licence number:  PSY4909 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0PL49090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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