Healthcare Provider Details

I. General information

NPI: 1891237533
Provider Name (Legal Business Name): ROBERT HULSEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S COLUMBIA AVE
TULSA OK
74114-3505
US

IV. Provider business mailing address

2123 E 60TH CT
TULSA OK
74105-7016
US

V. Phone/Fax

Practice location:
  • Phone: 918-688-7709
  • Fax:
Mailing address:
  • Phone: 918-508-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1485
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: