Provider Demographics
NPI:1194732396
Name:SHULLA, BARBARA K (LMHC, LMFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:K
Last Name:SHULLA
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:K
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LMFT
Mailing Address - Street 1:3148 LAKE RD N
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9402
Mailing Address - Country:US
Mailing Address - Phone:585-314-3057
Mailing Address - Fax:
Practice Address - Street 1:3148 LAKE RD N
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-9402
Practice Address - Country:US
Practice Address - Phone:585-314-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000146101YM0800X
NY000208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist