Provider Demographics
NPI:1558772772
Name:MILLIKEN, TULSI (PHD)
Entity Type:Individual
Prefix:
First Name:TULSI
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230836
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0836
Mailing Address - Country:US
Mailing Address - Phone:760-603-8661
Mailing Address - Fax:
Practice Address - Street 1:6813 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3925
Practice Address - Country:US
Practice Address - Phone:760-603-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9853103TC0700X
CAMFC20253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL985300OtherBLUE SHIELD OF CALIFORNIA