Provider Demographics
NPI:1558570796
Name:HULL, GARY DANIEL (MDIV, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DANIEL
Last Name:HULL
Suffix:
Gender:M
Credentials:MDIV, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1425
Mailing Address - Country:US
Mailing Address - Phone:408-947-2607
Mailing Address - Fax:
Practice Address - Street 1:22505 WOODROE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3410
Practice Address - Country:US
Practice Address - Phone:510-537-2869
Practice Address - Fax:510-537-9222
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
CA694651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral