=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164723235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL DIANA HULTS LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2010
-----------------------------------------------------
Last Update Date | 11/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1849 ROUTE 6
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-661-2884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 MEY CRESCENT RD
-----------------------------------------------------
City | STORMVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12582-5624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-878-5173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 001326
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------