Individual
SUSANNAH TULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED.
Contact information
Practice address
470 FOREST AVENUE, 300, PORTLAND, ME 04101
(207) 854-1030
Mailing address
470 FORRESTER AVENUE, 300, PORTLAND, ME 04101
(207) 854-1030
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC4200
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC4200
MAINECARE
ME
Enumeration date
03/05/2015
Last updated
03/05/2015
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