Healthcare Provider Details

I. General information

NPI: 1407111727
Provider Name (Legal Business Name): HARRY B HULL MA LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16824 KERCHEVAL AVE STE 215
GROSSE POINTE PARK MI
48230-1563
US

IV. Provider business mailing address

1012 SOMERSET AVE
GROSSE POINTE PARK MI
48230-1334
US

V. Phone/Fax

Practice location:
  • Phone: 313-215-0385
  • Fax:
Mailing address:
  • Phone: 313-215-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301002890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: