Healthcare Provider Details

I. General information

NPI: 1558782466
Provider Name (Legal Business Name): HOLLY E HULST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20174 FRONT ST NE
POULSBO WA
98370-7445
US

IV. Provider business mailing address

PO BOX 1611
POULSBO WA
98370-0197
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-1141
  • Fax: 360-697-2395
Mailing address:
  • Phone: 360-697-1141
  • Fax: 360-697-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60407830
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: