Healthcare Provider Details

I. General information

NPI: 1396010419
Provider Name (Legal Business Name): DONALD RAY HULEN MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 S CENTRAL AVE 204 AND 205
LOS ANGELES CA
90059-2897
US

IV. Provider business mailing address

4435 W 129TH ST 105
HAWTHORNE CA
90250-5178
US

V. Phone/Fax

Practice location:
  • Phone: 213-200-7174
  • Fax:
Mailing address:
  • Phone: 213-200-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: