Provider Demographics
NPI:1639253461
Name:HULBERT, MARK EDWARD (MACP, LLP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:HULBERT
Suffix:
Gender:M
Credentials:MACP, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3170
Mailing Address - Country:US
Mailing Address - Phone:517-351-2590
Mailing Address - Fax:517-351-2733
Practice Address - Street 1:921 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3170
Practice Address - Country:US
Practice Address - Phone:517-351-2590
Practice Address - Fax:517-351-2733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011290101Y00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013102OtherMCCLAREN
MI1013102OtherMCCLAREN