Healthcare Provider Details

I. General information

NPI: 1093497075
Provider Name (Legal Business Name): TERESA HULSEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E GOVERNMENT ST STE A
BRANDON MS
39042-3238
US

IV. Provider business mailing address

404 STONEYBROOK DR
BRANDON MS
39042-3501
US

V. Phone/Fax

Practice location:
  • Phone: 769-210-4593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number621109
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: