MEDICARE: KIMBERLY TULA

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

General Provider Information

NPI Number	:	1861940900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY TULA

Provider Business Mailing Address
First Line	:	400 WASHINGTON ST STE 106
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-4764
Country	:	US
Telephone Number	:	781-817-6675
Fax Number	:	781-817-6745

Provider Business Practice Location Address
First Line	:	400 WASHINGTON ST STE 106
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-4764
Country	:	US
Telephone Number	:	781-817-6675
Fax Number	:	781-817-6745

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

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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Directions to “ KIMBERLY TULA ” Practice Location

Language	Start Address	Practice Location

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