Healthcare Provider Details

I. General information

NPI: 1538544747
Provider Name (Legal Business Name): KRISTEN HULL-HOUGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12377 91ST AVENUE NORTH
SEMINOLE FL
33772
US

IV. Provider business mailing address

2515 W CENTRAL PARK AVE
DAVENPORT IA
52804-2502
US

V. Phone/Fax

Practice location:
  • Phone: 563-508-2268
  • Fax:
Mailing address:
  • Phone: 563-508-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number076533
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: