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General NPI Number Information
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NPI Number | 1992155352
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Entity Type | Individual
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Provider Name | KELLY HULL LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 117 S 6TH AVE CLC OFFICE
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City | MAYWOOD
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State | IL
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Zip | 60153-1305
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Country | US
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Telephone | 708-344-5536
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Fax | 708-344-5535
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Provider Business Mailing Address
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Address Line | 1118 N HARLEM AVE APT D
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City | RIVER FOREST
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State | IL
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Zip | 60305-1559
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Country | US
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Telephone | 312-399-7065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180011054
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178009412
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License Number State | IL
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