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NPI Code Detail

MEDICARE: MS. GEORGETTA JEAN HULL LCSW

MEDICARE: MS. GEORGETTA JEAN HULL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2001024583MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12001024583OTHERMSMO. STATE LICENSE

General Provider Information

NPI Number : 1215912571
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GEORGETTA JEAN HULL LCSW
Provider Business Mailing Address
First Line : 340 KELLEY PKWY
Second Line :
City : MEXICO
State : MO
Zip : 65265-3811
Country : US
Telephone Number : 573-582-1234
Fax Number : 573-582-1212
Provider Business Practice Location Address
First Line : 340 KELLEY PKWY
Second Line :
City : MEXICO
State : MO
Zip : 65265-3811
Country : US
Telephone Number : 573-582-1234
Fax Number : 573-582-1212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 06/26/2023

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Directions to “ MS. GEORGETTA JEAN HULL LCSW” Practice Location

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