Healthcare Provider Details

I. General information

NPI: 1578074373
Provider Name (Legal Business Name): JOSEPH HULL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE STE D
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

5060 CASCADE RD SE STE D
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-450-8245
  • Fax:
Mailing address:
  • Phone: 616-450-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801101120
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: