Provider Demographics
NPI:1083647168
Name:HULS, KATHRYN T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:T
Last Name:HULS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 LINCOLNWAY STE G
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5852
Mailing Address - Country:US
Mailing Address - Phone:773-935-4700
Mailing Address - Fax:773-935-4701
Practice Address - Street 1:8091 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-7068
Practice Address - Country:US
Practice Address - Phone:219-940-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010809103TC0700X
IN914179103TS0200X
IN20040963A103TC0700X
IN20040963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200185670Medicaid