| Doctor Name: | MELINDA TULLIS |
| NPI Number: | 1063881175 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | TCADC |
| License Number: | T16003 |
| Business Practice Address: | 9 N 4th Ave Marshalltown, IA - 501581836 |
| Business Phone Number: | 6417525421 |
| Business Fax Number: | 6417527211 |
| Mailing Address: | Po Box 1453, MARSHALLTOWN |
| State: | IA |
| Postal Code: | 501581453 |
| Phone Number: | 6417525421 |
| Fax Number: | 6417527211 |
| NPI Enumeration Date: | 09/18/2015 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | T16003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |