Healthcare Provider Details

I. General information

NPI: 1578767703
Provider Name (Legal Business Name): MICHELLE L TULLOCK LCSW, MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N UNIVERSITY DR STE 350
CORAL SPRINGS FL
33071-6000
US

IV. Provider business mailing address

1725 N UNIVERSITY DR STE 350
CORAL SPRINGS FL
33071-6000
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-2700
  • Fax: 954-227-2704
Mailing address:
  • Phone: 954-227-2700
  • Fax: 954-227-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: