Doctor Name: | MICHAEL KULLA |
NPI Number: | 1679638613 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 3413 |
Business Practice Address: | 42 Gretna Rd Pleasant Valley, NY - 125696948 |
Business Phone Number: | 8456351144 |
Business Fax Number: | 8456351948 |
Mailing Address: | 42 Gretna Rd, PLEASANT VALLEY |
State: | NY |
Postal Code: | 125696948 |
Phone Number: | 8456351144 |
Fax Number: | 8456351948 |
NPI Enumeration Date: | 12/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3413 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |