Healthcare Provider Details

I. General information

NPI: 1194122549
Provider Name (Legal Business Name): CHRISTINA GULLEY SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 WADE AVE
ASHTABULA OH
44004-9435
US

IV. Provider business mailing address

2302 WADE AVENUE
ASHTABULA OH
44004
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-1240
  • Fax: 441-992-1242
Mailing address:
  • Phone: 440-992-1240
  • Fax: 441-992-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20654683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: