Provider Demographics
NPI:1508577164
Name:HULST, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HULST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BRIGGSMORE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4234
Mailing Address - Country:US
Mailing Address - Phone:209-526-1476
Mailing Address - Fax:209-526-0908
Practice Address - Street 1:200 W BRIGGSMORE AVE STE I
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4234
Practice Address - Country:US
Practice Address - Phone:209-526-1476
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional