Provider Demographics
NPI:1366813412
Name:TULLY, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TULLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BEVERLY COMMONS DR APT 21
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5555
Mailing Address - Country:US
Mailing Address - Phone:413-313-3120
Mailing Address - Fax:
Practice Address - Street 1:50 DUNHAM RDG RD
Practice Address - Street 2:SUITES 3200-3350
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1882
Practice Address - Country:US
Practice Address - Phone:978-600-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health