Provider Demographics
NPI:1316970718
Name:TULLIUS, VICTORIA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:TULLIUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4098
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-4098
Mailing Address - Country:US
Mailing Address - Phone:530-342-2558
Mailing Address - Fax:530-342-2558
Practice Address - Street 1:341 BROADWAY ST
Practice Address - Street 2:SUITE 221
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5342
Practice Address - Country:US
Practice Address - Phone:530-342-2558
Practice Address - Fax:530-342-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2019-09-11
Deactivation Date:2019-02-27
Deactivation Code:
Reactivation Date:2019-09-11
Provider Licenses
StateLicense IDTaxonomies
CALCS134841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24697ZMedicare ID - Type Unspecified