Provider Demographics
NPI:1487691341
Name:RICHARD W. HURLBUT
Entity type:Organization
Organization Name:RICHARD W. HURLBUT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HURLBUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-344-2016
Mailing Address - Street 1:100 BREMMER ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-6032
Mailing Address - Country:US
Mailing Address - Phone:715-344-2016
Mailing Address - Fax:715-344-1715
Practice Address - Street 1:100 BREMMER ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-6032
Practice Address - Country:US
Practice Address - Phone:715-344-2016
Practice Address - Fax:715-344-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-08-30
Deactivation Date:2008-10-07
Deactivation Code:
Reactivation Date:2010-08-25
Provider Licenses
StateLicense IDTaxonomies
WI881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39024400Medicaid
WI084026001Medicare ID - Type Unspecified
WIR78258Medicare UPIN