Provider Demographics
NPI:1053518142
Name:HURYN, JEAN S (LPA)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:S
Last Name:HURYN
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CAMELIA RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7604
Mailing Address - Country:US
Mailing Address - Phone:252-671-1434
Mailing Address - Fax:252-638-3900
Practice Address - Street 1:1401 PARK AVE.
Practice Address - Street 2:PROMISE PLACE
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5502
Practice Address - Country:US
Practice Address - Phone:252-636-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1975103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107432Medicaid
NC141FGOtherBCBS