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General NPI Number Information
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NPI Number | 1073753612
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Entity Type | Individual
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Provider Name | MATTHEW T. TULL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2500 N STATE ST DEPARTMENT OF PSYCHIATRY
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-6518
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST DEPARTMENT OF PSYCHIATRY
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-6518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301019358
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 48 834
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License Number State | MS
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