Individual
MARY GULLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3201 KNIGHT ST, APT. 207, SHREVEPORT, LA 71105-2706
(318) 415-9012
Mailing address
3201 KNIGHT ST., APT. 207, SHREVEPORT, LA 71105
(318) 415-9012
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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