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General NPI Number Information
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NPI Number | 1366797193
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH TULL LPC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 23801 CALABASAS RD SUITE 2036
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City | CALABASAS
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State | CA
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Zip | 91302-3462
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Country | US
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Telephone | 818-485-4694
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Fax |
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Provider Business Mailing Address
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Address Line | 7609 HOLLINS RD
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City | RICHMOND
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State | VA
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Zip | 23229-6655
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Country | US
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Telephone | 804-683-8159
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2195
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005281
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License Number State | VA
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