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NPI Code Detail

MEDICARE: PATRICK TULLY LICENSED MARRIAGE AND FAMILY THERAPIST INC

MEDICARE: PATRICK TULLY LICENSED MARRIAGE AND FAMILY THERAPIST INC
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
1101YP2500XProfessional Counselor
2103TC0700XClinical Psychologist
31041C0700XClinical Social Worker
4101Y00000XCounselor
5101YM0800XMental Health Counselor
6106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1427624121
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATRICK TULLY LICENSED MARRIAGE AND FAMILY THERAPIST INC
Provider Business Mailing Address
First Line : 10866 WASHINGTON BLVD # 1329
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-3610
Country : US
Telephone Number : 323-819-0747
Fax Number :
Provider Business Practice Location Address
First Line : 3685 MOTOR AVE STE 220
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-5746
Country : US
Telephone Number : 323-819-0747
Fax Number :
Authorized Official
Title or Position : OWNER/PRESIDENT/CEO
Name : PATRICK DAVEY TULLY
Credential : MA, LMFT
Telephone Number : 323-819-0747
Provider Enumeration Date : 06/02/2021
Last Update Date : 11/23/2023

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