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General NPI Number Information
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NPI Number | 1528267291
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Entity Type | Organization
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Legal Business Name | GATEWAY CONSULTATION & COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 20 AUSTIN ST
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City | MILTON
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State | MA
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Zip | 02186-1104
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Country | US
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Telephone | 781-843-2555
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Fax | 781-843-9199
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Provider Business Mailing Address
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Address Line | PO BOX 366422
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City | HYDE PARK
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State | MA
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Zip | 02136-0030
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Country | US
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Telephone | 781-843-2555
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Fax | 781-843-9199
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID P BULLIS
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Credential | PH.D.
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Telephone | 617-680-8096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6826
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License Number State | MA
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