Healthcare Provider Details

I. General information

NPI: 1023253010
Provider Name (Legal Business Name): BRYAN JOHN HULS LMFT, CEAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8318 UNIVERSITY AVE SUITE A
LA MESA CA
91941-3865
US

IV. Provider business mailing address

9602 MONTEMAR DR
SPRING VALLEY CA
91977-3425
US

V. Phone/Fax

Practice location:
  • Phone: 619-739-4718
  • Fax:
Mailing address:
  • Phone: 619-644-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC31129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: