Healthcare Provider Details

I. General information

NPI: 1013180397
Provider Name (Legal Business Name): HULL AND ASSOCIATES, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S FLORIDA AVE SUITE 11
LAKELAND FL
33813-3327
US

IV. Provider business mailing address

6700 S FLORIDA AVE SUITE 11
LAKELAND FL
33813-3327
US

V. Phone/Fax

Practice location:
  • Phone: 863-644-8241
  • Fax: 863-644-9025
Mailing address:
  • Phone: 863-644-8241
  • Fax: 863-644-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH6661
License Number StateFL

VIII. Authorized Official

Name: MR. KEVIN BOYD HULL
Title or Position: PRESIDENT
Credential: LMHC, NCC
Phone: 863-644-8241