MEDICARE: MARLIE MCNULTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		OH

General Provider Information

NPI Number	:	1912861527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLIE MCNULTY

Provider Business Mailing Address
First Line	:	7232 JUSTIN WAY
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4881
Country	:	US
Telephone Number	:	440-578-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	14701 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4115
Country	:	US
Telephone Number	:	440-578-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ MARLIE MCNULTY ” Practice Location

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