Healthcare Provider Details

I. General information

NPI: 1649054966
Provider Name (Legal Business Name): SCOTT ALAN HULLINGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ANTIGUA CIR
PALM SPRINGS CA
92264-8543
US

IV. Provider business mailing address

1201 ANTIGUA CIR
PALM SPRINGS CA
92264-8543
US

V. Phone/Fax

Practice location:
  • Phone: 812-205-4000
  • Fax:
Mailing address:
  • Phone: 812-205-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004843A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number71969
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34004843A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71969
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7049-C
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7049-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: