Healthcare Provider Details

I. General information

NPI: 1952320038
Provider Name (Legal Business Name): MARK FRED TULIN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3968
US

IV. Provider business mailing address

1512B STONEY LN
PHILADELPHIA PA
19115-4279
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-2110
  • Fax: 610-604-9510
Mailing address:
  • Phone: 215-677-4302
  • Fax: 215-673-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000012
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: