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NPI Code Detail

MEDICARE: DR. PAMELA ANITA GULLEY ED.D.

MEDICARE: DR. PAMELA ANITA GULLEY ED.D.
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
1103TC2200XClinical Child & Adolescent Psychologist3567OH
2103TF0000XFamily Psychologist3567OH
3103T00000XPsychologist3567OH

General Provider Information

NPI Number : 1215150123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA ANITA GULLEY ED.D.
Provider Business Mailing Address
First Line : 1251 NILLES RD STE 5
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-7205
Country : US
Telephone Number : 513-939-0300
Fax Number : 513-939-0310
Provider Business Practice Location Address
First Line : 1251 NILLES RD STE 5
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-7205
Country : US
Telephone Number : 513-939-0300
Fax Number : 513-939-0310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 12/03/2018

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