Active NPI
Jacqueline Terry Hurst, LMSW
- Clinical Social Worker
- Livonia, MI
National Provider Identifier
1568415545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 075134
- Practice address
- 15370 Levan Rd.
Ste 2 Livonia Counseling Center
Livonia, MI 48154 - Phone
- (734) 744-0170
- Fax
- (734) 744-0171
- NPI assigned
- May 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 075134 | NY | Primary |
Addresses
Primary practice location
15370 Levan Rd.
Ste 2 Livonia Counseling Center
Livonia, MI 48154
Mailing address
485 Rock Creek Dr.
Ann Arbor, MI 48104
Phone (734) 662-9469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07300075134LI | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 075134 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Schuyler County Mental Health | Clinical | Past | Accepting new patients |
| Schuyler County | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulance
- Watkins Glen, NY
- NPI 1205544012
-
- Clinical Social Worker
- Watkins Glen, NY
- NPI 1003869165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457481600000",
"number": "1568415545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "485 ROCK CREEK DR.",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48104",
"telephone_number": "734-662-9469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15370 LEVAN RD.",
"address_2": "STE 2 LIVONIA COUNSELING CENTER",
"city": "LIVONIA",
"state": "MI",
"postal_code": "48154",
"telephone_number": "734-744-0170",
"fax_number": "734-744-0171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HURST",
"first_name": "JACQUELINE",
"middle_name": "TERRY",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-18",
"last_updated": "2016-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "075134",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07300075134LI",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.