Provider Demographics
NPI:1174700868
Name:BRIDGET HURT, PSY.D. & ASSOCIATES LLC
Entity type:Organization
Organization Name:BRIDGET HURT, PSY.D. & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:573-776-6236
Mailing Address - Street 1:907 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4300
Mailing Address - Country:US
Mailing Address - Phone:573-776-6236
Mailing Address - Fax:573-776-6236
Practice Address - Street 1:907 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4300
Practice Address - Country:US
Practice Address - Phone:573-776-6236
Practice Address - Fax:573-776-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS 000587101YP2500X
MO2000159807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty