Provider Demographics
NPI:1356072698
Name:DR. TULSA KNOX PSYCHOLOGIAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DR. TULSA KNOX PSYCHOLOGIAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TULSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:845-702-8764
Mailing Address - Street 1:124 RITCH AVE W APT A303
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6965
Mailing Address - Country:US
Mailing Address - Phone:845-702-8764
Mailing Address - Fax:
Practice Address - Street 1:25 8TH AVE STE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3755
Practice Address - Country:US
Practice Address - Phone:845-702-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003748OtherSTATE OF CT
NY021220OtherNY STATE