Healthcare Provider Details

I. General information

NPI: 1437183555
Provider Name (Legal Business Name): BRENDA SUSAN HULL L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N YORK ST BLDG 2 SUITE 34
MUSKOGEE OK
74403-3123
US

IV. Provider business mailing address

928 N YORK ST BLDG 2 SUITE 34
MUSKOGEE OK
74403-3123
US

V. Phone/Fax

Practice location:
  • Phone: 918-869-2823
  • Fax: 918-683-0616
Mailing address:
  • Phone: 918-869-2823
  • Fax: 918-683-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1033
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: