Healthcare Provider Details

I. General information

NPI: 1639253461
Provider Name (Legal Business Name): MARK EDWARD HULBERT M.A.C.P., L.L.P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 ABBOTT RD
EAST LANSING MI
48823-3170
US

IV. Provider business mailing address

921 ABBOTT RD
EAST LANSING MI
48823-3170
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-2590
  • Fax: 517-351-2733
Mailing address:
  • Phone: 517-351-2590
  • Fax: 517-351-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6301011290
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301011290
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: