Healthcare Provider Details

I. General information

NPI: 1144451360
Provider Name (Legal Business Name): JESSICA HULIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 1ST ST
NAPA CA
94559-2841
US

IV. Provider business mailing address

2383 ADRIAN ST
NAPA CA
94558-5003
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number55047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: