Basic Information
Provider Information
NPI: 1558875542
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HULLIHEN
FirstName: BRETT
MiddleName: WILLIAM
NamePrefix:  
NameSuffix:  
Credential: MS, LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14014 ROUTE 31
Address2:  
City: ALBION
State: NY
PostalCode: 144119301
CountryCode: US
TelephoneNumber: 5855897066
FaxNumber: 5855896395
Practice Location
Address1: 14014 ROUTE 31
Address2:  
City: ALBION
State: NY
PostalCode: 14411
CountryCode: US
TelephoneNumber: 5855897066
FaxNumber: 5855896395
Other Information
ProviderEnumerationDate: 11/29/2017
LastUpdateDate: 11/07/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X008672-1NYY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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