Healthcare Provider Details

I. General information

NPI: 1770964132
Provider Name (Legal Business Name): ALEXANDRA HULST PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KOKOPELLI BLVD STE 1
FRUITA CO
81521-3308
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-9894
  • Fax: 970-858-1331
Mailing address:
  • Phone: 970-858-9894
  • Fax: 970-858-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001383
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: