Provider Demographics
NPI:1548271299
Name:HULL, MANDY SUE (BS,BHRS)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:SUE
Last Name:HULL
Suffix:
Gender:F
Credentials:BS,BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-2357
Mailing Address - Country:US
Mailing Address - Phone:580-650-9329
Mailing Address - Fax:
Practice Address - Street 1:90 NORTH 31ST STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-9375
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor