Provider Demographics
NPI:1942487004
Name:HULSE, ELLIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELLIS
Middle Name:
Last Name:HULSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 MORNINGSIDE CT
Mailing Address - Street 2:93
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4345
Mailing Address - Country:US
Mailing Address - Phone:516-840-2468
Mailing Address - Fax:
Practice Address - Street 1:2401 W BAY DR
Practice Address - Street 2:STE 117
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4902
Practice Address - Country:US
Practice Address - Phone:516-840-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079962101YM0800X
FLSW120651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty