Healthcare Provider Details

I. General information

NPI: 1629102256
Provider Name (Legal Business Name): JANE A HULL LP, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARMY BEHAVIORAL HEALTH 1060 GAFFNEY ROAD STOP# 7420
FT. WAINWRIGHT AK
99703
US

IV. Provider business mailing address

ARMY BEHAVIORAL HEALTH 1060 GAFFNEY ROAD STOP# 7420
FT. WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-6059
  • Fax:
Mailing address:
  • Phone: 907-361-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1214
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62389143
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP4974
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: