Provider Demographics
NPI:1679893630
Name:HULL, KATHERINE B (PSYD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:HULL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WYOMING BLVD NE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1000
Mailing Address - Country:US
Mailing Address - Phone:505-633-0643
Mailing Address - Fax:
Practice Address - Street 1:2601 WYOMING BLVD NE STE 116
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1000
Practice Address - Country:US
Practice Address - Phone:505-633-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3527103TC0700X
NM1205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical