=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497113252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICK HULS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2016
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1932 ASPEN CIRCLE SUITE I
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-380-3697
-----------------------------------------------------
Fax | 888-505-7909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5023
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68802-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-380-3697
-----------------------------------------------------
Fax | 888-505-7909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MR. RICK LYNN HULS
-----------------------------------------------------
Credential | LIMHP
-----------------------------------------------------
Telephone | 308-380-3697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------