Healthcare Provider Details

I. General information

NPI: 1477110286
Provider Name (Legal Business Name): RYAN JAMES HULING LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W FERRY ST
BERRIEN SPRINGS MI
49103-1109
US

IV. Provider business mailing address

57043 M 51 S
DOWAGIAC MI
49047-9765
US

V. Phone/Fax

Practice location:
  • Phone: 269-815-5331
  • Fax:
Mailing address:
  • Phone: 269-845-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: