Basic Information
| Provider Information | |||||||||
| NPI: | 1801540745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 COHASSET RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308945933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 COHASSET RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308945933 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2022 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.