Provider Demographics
NPI:1235945049
Name:HURLBUT, MADISON DEANN (M ED, BCBA, COBA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:DEANN
Last Name:HURLBUT
Suffix:
Gender:F
Credentials:M ED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 YOUNGSTOWN WARREN RD STE C
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 YOUNGSTOWN WARREN RD STE C
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4626
Practice Address - Country:US
Practice Address - Phone:330-505-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-24-76334103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst