Provider Demographics
NPI:1467562603
Name:HULETT, DOUG (LPC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:HULETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5363
Mailing Address - Country:US
Mailing Address - Phone:208-552-7100
Mailing Address - Fax:208-552-7101
Practice Address - Street 1:496 A ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3617
Practice Address - Country:US
Practice Address - Phone:208-552-7100
Practice Address - Fax:208-552-7101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID214133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1378585Medicare ID - Type UnspecifiedGROUP