Provider Demographics
NPI:1811507593
Name:HULSE, ASIA ROSE
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:ROSE
Last Name:HULSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6967 S RIVER GATE DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1574
Mailing Address - Country:US
Mailing Address - Phone:801-453-9625
Mailing Address - Fax:801-944-7347
Practice Address - Street 1:7138 S 2000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3757
Practice Address - Country:US
Practice Address - Phone:801-942-1800
Practice Address - Fax:801-944-1865
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12407370-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical