Provider Demographics
NPI:1962436501
Name:LULL, DAVID C (MSSS, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:LULL
Suffix:
Gender:M
Credentials:MSSS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 NORTH 79TH AVENUE
Mailing Address - Street 2:SUITE C-133
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8471
Mailing Address - Country:US
Mailing Address - Phone:623-979-2424
Mailing Address - Fax:623-979-2529
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:SUITE C-133
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8471
Practice Address - Country:US
Practice Address - Phone:623-979-2424
Practice Address - Fax:623-979-2529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1405OtherSTATE LICENSE LCSW NUMBER
AZ1405OtherSTATE LICENSE LCSW NUMBER