Basic Information
| Provider Information | |||||||||
| NPI: | 1548271299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | BS,BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736012357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806509329 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 90 NORTH 31ST STREET | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803236021 | ||||||||
| FaxNumber: | 5803239375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.