Individual provider · Type 1 NPI
Susannah Tully, M. ED.
Professional Counselor · Portland, ME
NPI number
1558754200
Active
Practice location
470 Forest Avenue, 300
Portland, ME 04101
Mailing address
470 Forrester Avenue, 300
Portland, ME 04101
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | CC4200 (ME) |
Professional Counselor: Definition to come...
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About NPI 1558754200
Susannah Tully, M. ED.'s National Provider Identifier is 1558754200, issued on Mar 5, 2015. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Portland, ME. The record was last updated on Mar 5, 2015.