Provider Demographics
NPI:1194737502
Name:JUDITH ANNE TULLY
Entity type:Organization
Organization Name:JUDITH ANNE TULLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-629-1138
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77501
Mailing Address - Country:US
Mailing Address - Phone:832-672-6318
Mailing Address - Fax:832-672-6319
Practice Address - Street 1:4001 PRESTON AVENUE
Practice Address - Street 2:SUITE 145
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:832-672-6318
Practice Address - Fax:832-672-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty