Provider Demographics
NPI:1225205420
Name:TULLIS, CHARLES L JR (LMFT)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:TULLIS
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FAITH AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1588
Mailing Address - Country:US
Mailing Address - Phone:678-982-3295
Mailing Address - Fax:
Practice Address - Street 1:609S S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-6679
Practice Address - Country:US
Practice Address - Phone:678-982-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005547101YP2500X
LA880106H00000X
KS2927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional