Healthcare Provider Details

I. General information

NPI: 1700823432
Provider Name (Legal Business Name): DEBRA SUZANNE HULLENDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE SUZANNE HULLENDER LPC

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S BROADWAY
SALISBURY MO
65281
US

IV. Provider business mailing address

609 S BROADWAY
SALISBURY MO
65281
US

V. Phone/Fax

Practice location:
  • Phone: 660-388-5058
  • Fax: 660-388-5058
Mailing address:
  • Phone: 660-388-5058
  • Fax: 660-388-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0001429
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: