Provider Demographics
NPI:1124388186
Name:TULA WELLNESS LLC
Entity Type:Organization
Organization Name:TULA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-219-9039
Mailing Address - Street 1:544 E OGDEN AVE STE 700-317
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2698
Mailing Address - Country:US
Mailing Address - Phone:414-219-9039
Mailing Address - Fax:414-755-1305
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-219-9039
Practice Address - Fax:414-755-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB51459Medicare UPIN