Provider Demographics
NPI:1518917624
Name:STULL, RICHARD JEFFREY (DMIN, PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:STULL
Suffix:
Gender:M
Credentials:DMIN, PHD, LPC
Other - Prefix:DR
Other - First Name:R JEFFREY
Other - Middle Name:JEFFREY
Other - Last Name:STULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMIN, PHD, LMHC, LPC
Mailing Address - Street 1:266 HUCKLEBERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:HELEN
Mailing Address - State:GA
Mailing Address - Zip Code:30545-3302
Mailing Address - Country:US
Mailing Address - Phone:678-517-6699
Mailing Address - Fax:
Practice Address - Street 1:266 HUCKLEBERRY HILL DR
Practice Address - Street 2:
Practice Address - City:HELEN
Practice Address - State:GA
Practice Address - Zip Code:30545-3302
Practice Address - Country:US
Practice Address - Phone:678-517-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3952101YM0800X
101YP1600X
GALPC4036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110074047AMedicaid