Healthcare Provider Details

I. General information

NPI: 1760842223
Provider Name (Legal Business Name): DANIELLE HULSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

IV. Provider business mailing address

9639 STATE ROUTE 1389
LEWISPORT KY
42351-9616
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6500
  • Fax:
Mailing address:
  • Phone: 270-314-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYPAT00222587
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSYPAT00222587
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: