Healthcare Provider Details

I. General information

NPI: 1003329434
Provider Name (Legal Business Name): WENDY HULL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S MAIN ST
LEBANON OR
97355-3109
US

IV. Provider business mailing address

104 4TH AVE SW RM 238
ALBANY OR
97321-2804
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-5932
  • Fax:
Mailing address:
  • Phone: 541-967-3819
  • Fax: 541-967-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0616
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: