Healthcare Provider Details

I. General information

NPI: 1659456713
Provider Name (Legal Business Name): JENNIFER TULLI LISW-S, LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DRIVE METROHEALTH MEDICAL CENTER
CLEVELAND OH
44109-3322
US

IV. Provider business mailing address

24024 E OAKLAND RD
BAY VILLAGE OH
44140-2829
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-8305
  • Fax:
Mailing address:
  • Phone: 440-617-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162381
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0010063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: