Provider Demographics
NPI:1922854249
Name:HURLESS, NICOLE LEIGH (PHD, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:HURLESS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:HURLESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:8217 DOWNE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3005
Mailing Address - Country:US
Mailing Address - Phone:410-920-4174
Mailing Address - Fax:
Practice Address - Street 1:1801 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2732
Practice Address - Country:US
Practice Address - Phone:806-402-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health