Provider Demographics
NPI:1235209305
Name:TULBERT, MINDY P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:P
Last Name:TULBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 PRESTON PARK BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3635
Mailing Address - Country:US
Mailing Address - Phone:972-985-2439
Mailing Address - Fax:972-985-2120
Practice Address - Street 1:4975 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 790
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5164
Practice Address - Country:US
Practice Address - Phone:972-985-2439
Practice Address - Fax:972-985-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00400PMedicare ID - Type Unspecified