Provider Demographics
NPI:1700823432
Name:HULLENDER, DEBRA SUZANNE (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUZANNE
Last Name:HULLENDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:SUZANNE
Other - Last Name:HULLENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:609 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MO
Mailing Address - Zip Code:65281
Mailing Address - Country:US
Mailing Address - Phone:660-388-5058
Mailing Address - Fax:660-388-5058
Practice Address - Street 1:609 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:65281
Practice Address - Country:US
Practice Address - Phone:660-388-5058
Practice Address - Fax:660-388-5058
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0001429101Y00000X
MO001429101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496824210Medicaid
MO233367OtherHEALTHLINK
MO195083OtherBLUE SHIELD/BLUE CHOICE