Organization
GATEWAY CONSULTATION & COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID P BULLIS PH.D. (OWNER)
(617) 680-8096
Entity
Organization
Contact information
Practice address
20 AUSTIN ST, MILTON, MA 02186-1104
(781) 843-2555
(781) 843-9199
Mailing address
PO BOX 366422, HYDE PARK, MA 02136-0030
(781) 843-2555
(781) 843-9199
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6826
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9758551
—
MA
01
—
W10653
BLUE CROSS BLUE SHIELD
MA
Enumeration date
07/13/2007
Last updated
10/17/2024
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