Healthcare Provider Details

I. General information

NPI: 1104049394
Provider Name (Legal Business Name): BRENDA HULTS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 FORT HENRY DR
KINGSPORT TN
37664-4005
US

IV. Provider business mailing address

140 CEDAR KNOLL CIR
ROGERSVILLE TN
37857-7680
US

V. Phone/Fax

Practice location:
  • Phone: 423-392-2975
  • Fax: 423-392-2983
Mailing address:
  • Phone: 423-612-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number834
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: