Provider Demographics
NPI:1508741372
Name:HURST, SERRA (BAMS, NMT)
Entity type:Individual
Prefix:DR
First Name:SERRA
Middle Name:
Last Name:HURST
Suffix:
Gender:X
Credentials:BAMS, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41338 FLASHS HONOR LN
Mailing Address - Street 2:
Mailing Address - City:GREENOUGH
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9660
Mailing Address - Country:US
Mailing Address - Phone:406-830-9127
Mailing Address - Fax:
Practice Address - Street 1:127 N HIGGINS AVE STE 204
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4457
Practice Address - Country:US
Practice Address - Phone:406-830-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 174H00000X
MT9083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174H00000XOther Service ProvidersHealth Educator