Provider Demographics
NPI:1366797193
Name:TULL, KELLY ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:TULL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 HOLLINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6655
Mailing Address - Country:US
Mailing Address - Phone:804-683-8159
Mailing Address - Fax:
Practice Address - Street 1:23801 CALABASAS RD
Practice Address - Street 2:SUITE 2036
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3462
Practice Address - Country:US
Practice Address - Phone:818-485-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2195101YP2500X
VA0701005281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional