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General NPI Number Information
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NPI Number | 1124388186
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Entity Type | Organization
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Legal Business Name | TULA WELLNESS LLC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 1220 DEWEY AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2504
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Country | US
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Telephone | 414-219-9039
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Fax | 414-755-1305
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Provider Business Mailing Address
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Address Line | 544 E OGDEN AVE STE 700-317
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City | MILWAUKEE
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State | WI
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Zip | 53202-2698
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Country | US
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Telephone | 414-219-9039
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Fax | 414-755-1305
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | USHA BEDI
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Credential |
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Telephone | 414-219-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 20958
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License Number State | WI
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