Healthcare Provider Details

I. General information

NPI: 1770763708
Provider Name (Legal Business Name): PATRICIA ANN HULL L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E MAIN ST
OTHELLO WA
99344-1146
US

IV. Provider business mailing address

338 S 10TH AVE
OTHELLO WA
99344-1422
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-5611
  • Fax:
Mailing address:
  • Phone: 509-488-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-3925
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: