Healthcare Provider Details

I. General information

NPI: 1861930265
Provider Name (Legal Business Name): FAHADA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WICHERS DR #205
MARRERO LA
70072-3041
US

IV. Provider business mailing address

433 CAPITOL DR
AVONDALE LA
70094-2457
US

V. Phone/Fax

Practice location:
  • Phone: 504-407-0709
  • Fax:
Mailing address:
  • Phone: 414-534-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: