Provider Demographics
NPI:1699706291
Name:HULSE, C KEITH (PHD)
Entity type:Individual
Prefix:DR
First Name:C
Middle Name:KEITH
Last Name:HULSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 KINGSTON PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3331
Mailing Address - Country:US
Mailing Address - Phone:865-264-4000
Mailing Address - Fax:865-588-6406
Practice Address - Street 1:2607 KINGSTON PIKE STE 250
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3331
Practice Address - Country:US
Practice Address - Phone:865-264-4000
Practice Address - Fax:865-588-6406
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3681783Medicaid
TN3681783Medicare ID - Type UnspecifiedMEDICARE