Provider Demographics
NPI:1790200442
Name:HULTS, JAMIE NICOLE (MAPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:HULTS
Suffix:
Gender:F
Credentials:MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IL
Mailing Address - Zip Code:62275-3516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 STATE AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IL
Practice Address - Zip Code:62275-3516
Practice Address - Country:US
Practice Address - Phone:217-821-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty