Healthcare Provider Details

I. General information

NPI: 1144286147
Provider Name (Legal Business Name): YVONNE LEANNE HULSEBOS M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE SUITE 600
FORT WORTH TX
76104-2158
US

IV. Provider business mailing address

4339 EL CAMPO AVE
FORT WORTH TX
76107-4214
US

V. Phone/Fax

Practice location:
  • Phone: 817-878-5298
  • Fax: 817-878-5289
Mailing address:
  • Phone: 817-377-9569
  • Fax: 817-878-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number99151
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: