MEDICARE: MICHAEL W. MCNULTY, LPC, LLC

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	LPC000664	GA

General Provider Information

NPI Number	:	1679660666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL W. MCNULTY, LPC, LLC

Provider Business Mailing Address
First Line	:	2330 SCENIC HWY S STE 204
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3115
Country	:	US
Telephone Number	:	770-289-8217
Fax Number	:	888-502-0589

Provider Business Practice Location Address
First Line	:	2330 SCENIC HWY S STE 204
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3115
Country	:	US
Telephone Number	:	770-289-8217
Fax Number	:	888-502-0589

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. MICHAEL WAYNE MCNULTY
Credential	:	LPC
Telephone Number	:	770-289-8217

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/21/2022

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