Provider Demographics
NPI:1366582397
Name:HULTMAN, JENNIFER (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HULTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:403 W ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4307
Mailing Address - Country:US
Mailing Address - Phone:512-388-4660
Mailing Address - Fax:512-246-8803
Practice Address - Street 1:403 W ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4307
Practice Address - Country:US
Practice Address - Phone:512-388-4660
Practice Address - Fax:512-246-8803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional