Provider Demographics
NPI:1629102256
Name:HULL, JANE A (LP, LADC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:HULL
Suffix:
Gender:F
Credentials:LP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ARMY BEHAVIORAL HEALTH
Mailing Address - Street 2:1060 GAFFNEY ROAD STOP# 7420
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703
Mailing Address - Country:US
Mailing Address - Phone:907-361-6059
Mailing Address - Fax:
Practice Address - Street 1:ARMY BEHAVIORAL HEALTH
Practice Address - Street 2:1060 GAFFNEY ROAD STOP# 7420
Practice Address - City:FT. WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1214101YA0400X
ND62389143101YP2500X
MNLP4974103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional