MEDICARE: EVAN SCHULLERY LPC

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	101YP2500X	Professional Counselor	PC012147	PA

General Provider Information

NPI Number	:	1487427217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN SCHULLERY LPC

Provider Business Mailing Address
First Line	:	1509 MANCHESTER CT APT 106
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 MANCHESTER CT APT 106
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3528
Country	:	US
Telephone Number	:	610-717-7045
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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