Provider Demographics
NPI:1285100925
Name:TULLY, PATRICK DAVEY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVEY
Last Name:TULLY
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10866 WASHINGTON BLVD # 1329
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3610
Mailing Address - Country:US
Mailing Address - Phone:323-819-0747
Mailing Address - Fax:
Practice Address - Street 1:3685 MOTOR AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5746
Practice Address - Country:US
Practice Address - Phone:323-819-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2024-02-16
Deactivation Date:2018-11-02
Deactivation Code:
Reactivation Date:2019-06-08
Provider Licenses
StateLicense IDTaxonomies
CA115115106H00000X
FLTPMF163106H00000X
TX205051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty