Provider Demographics
NPI:1831662980
Name:ELIZABETH TULLY, LCSW, LLC
Entity Type:Organization
Organization Name:ELIZABETH TULLY, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-541-9929
Mailing Address - Street 1:590 MISSOURI AVE STE 206C
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3084
Mailing Address - Country:US
Mailing Address - Phone:812-541-9929
Mailing Address - Fax:812-461-0426
Practice Address - Street 1:590 MISSOURI AVE STE 206C
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3084
Practice Address - Country:US
Practice Address - Phone:812-541-9929
Practice Address - Fax:812-461-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health