Healthcare Provider Details

I. General information

NPI: 1144620329
Provider Name (Legal Business Name): COURTNEY HULSE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 MAIN ST STE 205
HUNTINGTON NY
11743-6917
US

IV. Provider business mailing address

177 MAIN ST STE 205
HUNTINGTON NY
11743-6917
US

V. Phone/Fax

Practice location:
  • Phone: 631-258-4899
  • Fax:
Mailing address:
  • Phone: 631-258-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: