Provider Demographics
NPI:1861046542
Name:HULL, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:HULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 JUANIPERO WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8580
Mailing Address - Country:US
Mailing Address - Phone:541-816-4131
Mailing Address - Fax:
Practice Address - Street 1:17640 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6733
Practice Address - Country:US
Practice Address - Phone:503-489-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health