Healthcare Provider Details

I. General information

NPI: 1881438455
Provider Name (Legal Business Name): HULL INTEGRATIVE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HIGHWAY 2 STE 202B
SANDPOINT ID
83864-2434
US

IV. Provider business mailing address

1205 HIGHWAY 2 STE 202B
SANDPOINT ID
83864-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-4877
  • Fax: 208-908-0039
Mailing address:
  • Phone: 208-263-4877
  • Fax: 208-908-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBIN LYN HULL
Title or Position: PROVIDER/ OWNER
Credential: MS, LCPC
Phone: 208-263-4877