Provider Demographics
NPI:1407111727
Name:HULL, HARRY B (MA LLP)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:B
Last Name:HULL
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1334
Mailing Address - Country:US
Mailing Address - Phone:313-215-0385
Mailing Address - Fax:
Practice Address - Street 1:16824 KERCHEVAL AVE STE 215
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1563
Practice Address - Country:US
Practice Address - Phone:313-215-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist