Healthcare Provider Details

I. General information

NPI: 1154441905
Provider Name (Legal Business Name): BEVERLY SHARON HULL PH.D.,L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 FORT ST RM 505
PORT HURON MI
48060
US

IV. Provider business mailing address

100 NB GRATIOT AVE
MOUNT CLEMENS MI
48043-2301
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-0099
  • Fax: 810-696-7339
Mailing address:
  • Phone: 586-783-2950
  • Fax: 586-690-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301006219
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: