=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629396221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINICK GULLI PSY.D., LMHC, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2010
-----------------------------------------------------
Last Update Date | 05/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 WINDHORST RIDGE DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33510-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-716-8936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S HOOVER BLVD SUITE 170
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33609-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-716-8936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH4337
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------