Provider Demographics
NPI:1235741216
Name:MCNULTY, TIERNEY WARD (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:WARD
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1155
Mailing Address - Country:US
Mailing Address - Phone:831-824-4002
Mailing Address - Fax:
Practice Address - Street 1:328 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1155
Practice Address - Country:US
Practice Address - Phone:831-824-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126222106H00000X
CA109492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist