Healthcare Provider Details

I. General information

NPI: 1699080077
Provider Name (Legal Business Name): DIANE L HULL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507A NATOMA ST
FOLSOM CA
95630-2523
US

IV. Provider business mailing address

507A NATOMA ST
FOLSOM CA
95630-2523
US

V. Phone/Fax

Practice location:
  • Phone: 916-261-2157
  • Fax:
Mailing address:
  • Phone: 916-261-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: