Healthcare Provider Details

I. General information

NPI: 1568102093
Provider Name (Legal Business Name): SOFIA ZULLI N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LYDA AVE APT 318
BOWLING GREEN KY
42104-3326
US

IV. Provider business mailing address

1910 LYDA AVE
BOWLING GREEN KY
42104-3326
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax:
Mailing address:
  • Phone: 740-727-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: