MEDICARE: TULI THERAPY AND CONSULTING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164229167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULI THERAPY AND CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	1751 JAMES RD
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-3644
Country	:	US
Telephone Number	:	651-208-5860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 JAMES RD
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-3644
Country	:	US
Telephone Number	:	651-208-5860
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST AND OWNER
Name	:	ELIZABETH S BANOVETZ
Credential	:	LMFT
Telephone Number	:	651-208-5860

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2025

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