=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902123862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUNTER TY HULL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2010
-----------------------------------------------------
Last Update Date | 04/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2205 E CEDAR RIDGE RD
-----------------------------------------------------
City | TISHOMINGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73460-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-371-5071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2205 E CEDAR RIDGE RD
-----------------------------------------------------
City | TISHOMINGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73460-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-371-5071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------