Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY-282 | ID |
Y | 103T00000X | Psychologist | PSY-282 | ID |
N | 103G00000X | Clinical Psychologist | PSY-282 | ID |
N | 103TC0700X | Clinical Psychologist | PSY-282 | ID |
N | 103TC1900X | Counseling Psychologist | PSY-282 | ID |
NPI | 1053689356 |
---|---|
Provider Name | Dr. Ryan J Hulbert |
First Address | Parma, ID 83660-7212 |
Second Address | Meridian, ID 83642-7289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2011 |
Last Update Date | 01/12/2011 |