Provider Demographics
NPI:1841273570
Name:HULBERT, THOMAS ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALAN
Last Name:HULBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25899 W 12 MILE RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1800
Mailing Address - Country:US
Mailing Address - Phone:248-415-4471
Mailing Address - Fax:248-809-6245
Practice Address - Street 1:25899 W 12 MILE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1800
Practice Address - Country:US
Practice Address - Phone:248-415-4471
Practice Address - Fax:248-809-6245
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301006332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR83831Medicare UPIN