Provider Demographics
NPI:1124179213
Name:TULLY, LORI ANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:TULLY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1101
Mailing Address - Country:US
Mailing Address - Phone:207-781-9012
Mailing Address - Fax:
Practice Address - Street 1:55 FIELD RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1101
Practice Address - Country:US
Practice Address - Phone:207-781-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional