Healthcare Provider Details

I. General information

NPI: 1699056481
Provider Name (Legal Business Name): LAURA HULL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TRINITY LAKES DR APT 254
SUN CITY CENTER FL
33573-7703
US

IV. Provider business mailing address

1850 LEE RD SUITE 250
WINTER PARK FL
32789-2115
US

V. Phone/Fax

Practice location:
  • Phone: 727-753-8558
  • Fax:
Mailing address:
  • Phone: 407-647-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: