Healthcare Provider Details

I. General information

NPI: 1033006564
Provider Name (Legal Business Name): WEATHERLY RAE HULSEY LPC-MHSP (TEMP)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CONTINENTAL PL STE 400
BRENTWOOD TN
37027-1073
US

IV. Provider business mailing address

5163 REGENT DR
NASHVILLE TN
37220-1912
US

V. Phone/Fax

Practice location:
  • Phone: 615-852-8988
  • Fax:
Mailing address:
  • Phone: 703-622-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8042
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: