Provider Demographics
NPI:1134536964
Name:HURLEY, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HURLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20885 REDWOOD RD # 420
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5915
Mailing Address - Country:US
Mailing Address - Phone:510-516-0435
Mailing Address - Fax:
Practice Address - Street 1:5184 CUNNINGHAM CT
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2538
Practice Address - Country:US
Practice Address - Phone:707-363-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99315106H00000X
CA78974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist