Healthcare Provider Details

I. General information

NPI: 1649321829
Provider Name (Legal Business Name): MICHAEL J LULEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 FAIRWAY DR STE C
FULTON MO
65251-4023
US

IV. Provider business mailing address

2625 FAIRWAY DR STE C
FULTON MO
65251-4023
US

V. Phone/Fax

Practice location:
  • Phone: 573-808-4131
  • Fax:
Mailing address:
  • Phone: 573-582-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001007816
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number979
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: