Provider Demographics
NPI:1134985930
Name:TULLY, ALEXIS (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:TULLY
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 1:7373 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE AL87
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253
Mailing Address - Country:US
Mailing Address - Phone:623-282-4009
Mailing Address - Fax:
Practice Address - Street 1:7373 N SCOTTSDALE RD
Practice Address - Street 2:SUITES A187 AND A199
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:480-524-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-220491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical