Provider Demographics
NPI:1346308780
Name:TRUDELL HULL, TAMMY L (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:TRUDELL HULL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:TRUDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:402 THORNTON ST
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333
Mailing Address - Country:US
Mailing Address - Phone:269-795-2243
Mailing Address - Fax:269-795-5315
Practice Address - Street 1:402 THORNTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333
Practice Address - Country:US
Practice Address - Phone:269-795-2243
Practice Address - Fax:269-795-5315
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL797306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7157369OtherAETNA
MI8008966970OtherBCBS