MEDICARE: MS. BARBARA K SHULLA LMHC, LMFT

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	101YM0800X	Mental Health Counselor	000146	NY
2	106H00000X	Marriage & Family Therapist	000208	NY

General Provider Information

NPI Number	:	1194732396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA K SHULLA LMHC, LMFT

Provider Business Mailing Address
First Line	:	3148 LAKE RD N
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9402
Country	:	US
Telephone Number	:	585-314-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3148 LAKE RD N
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9402
Country	:	US
Telephone Number	:	585-314-0357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/24/2016

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