1184239386 NPI number — MS. PRISCILLA TANISHIA HULEY LCPC

Table of content: MS. PRISCILLA TANISHIA HULEY LCPC (NPI 1184239386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184239386 NPI number — MS. PRISCILLA TANISHIA HULEY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULEY
Provider First Name:
PRISCILLA
Provider Middle Name:
TANISHIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184239386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 N GLENWOOD AVE APT 0E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRIFFITH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46319-1964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-227-7098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9445 INDIANAPOLIS BLVD # 1212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-227-4080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39004253A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 180014220 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39004253A . This is a "MENTAL HEALTH COUNSELOR LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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