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General NPI Number Information
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NPI Number | 1376624791
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Entity Type | Individual
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Provider Name | EDWIN FRED TULLOCH PHD LPC LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 543 E FREEMAN
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City | DUNCANVILLE
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State | TX
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Zip | 75116
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Country | US
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Telephone | 972-617-0242
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Fax | 254-637-2727
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Provider Business Mailing Address
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Address Line | 3908 DANZIG DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052
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Country | US
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Telephone | 972-617-0242
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Fax | 254-687-2727
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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 | 9172
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 773
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License Number State | TX
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