MEDICARE: DR. SANDRA MARIE THULL PSYD

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	103TC0700X	Clinical Psychologist	30589	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851445324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MARIE THULL PSYD

Provider Business Mailing Address
First Line	:	834 N HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-3106
Country	:	US
Telephone Number	:	972-839-0983
Fax Number	:	254-531-0510

Provider Business Practice Location Address
First Line	:	834 N HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-3106
Country	:	US
Telephone Number	:	972-839-0983
Fax Number	:	254-531-0510

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/10/2025

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