Healthcare Provider Details

I. General information

NPI: 1689110637
Provider Name (Legal Business Name): BEVERLY HULBIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 01/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BARBEQUE RD
MINDEN LA
71055-7865
US

IV. Provider business mailing address

191 BARBEQUE RD
MINDEN LA
71055-7865
US

V. Phone/Fax

Practice location:
  • Phone: 972-822-9582
  • Fax:
Mailing address:
  • Phone: 972-822-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5921
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: