Individual
DR. MATTHEW T. TULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF PSYCHIATRY, JACKSON, MS 39216-4500
(601) 815-6518
Mailing address
2500 N STATE ST, DEPARTMENT OF PSYCHIATRY, JACKSON, MS 39216-4500
(601) 815-6518
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301019358
MI
103TC0700X
Clinical Psychologist
48 834
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512I680055
MEDICARE PTAN
MS
Enumeration date
02/23/2009
Last updated
01/28/2025
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