Provider Demographics
NPI:1316069438
Name:HULL, KATHI ANN (MA)
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:ANN
Last Name:HULL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2911 EYDE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5381
Mailing Address - Country:US
Mailing Address - Phone:517-333-7733
Mailing Address - Fax:517-333-7733
Practice Address - Street 1:2911 EYDE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5381
Practice Address - Country:US
Practice Address - Phone:517-333-7733
Practice Address - Fax:517-333-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical