Healthcare Provider Details

I. General information

NPI: 1518412824
Provider Name (Legal Business Name): MICHAEL HULBERT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BOHANAN DR
VANDALIA OH
45377-2300
US

IV. Provider business mailing address

300 BOHANAN DR
VANDALIA OH
45377-2300
US

V. Phone/Fax

Practice location:
  • Phone: 937-750-9590
  • Fax:
Mailing address:
  • Phone: 937-750-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1200629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: