Provider Demographics
NPI:1144559857
Name:HULL, KENNETH LYNN (LPC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LYNN
Last Name:HULL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540724
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0724
Mailing Address - Country:US
Mailing Address - Phone:801-891-0400
Mailing Address - Fax:801-298-0846
Practice Address - Street 1:1038 W FOX HOLLOW DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-6008
Practice Address - Country:US
Practice Address - Phone:801-891-0400
Practice Address - Fax:801-298-0846
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5021920-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional