Provider Demographics
NPI:1023253010
Name:HULS, BRYAN JOHN (LMFT, CEAP)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOHN
Last Name:HULS
Suffix:
Gender:M
Credentials:LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 MONTEMAR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3425
Mailing Address - Country:US
Mailing Address - Phone:619-644-1789
Mailing Address - Fax:
Practice Address - Street 1:8318 UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3865
Practice Address - Country:US
Practice Address - Phone:619-739-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist