Provider Demographics
NPI:1396081915
Name:TULEY, CARA H (PCC-S)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:H
Last Name:TULEY
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:L
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCC-S
Mailing Address - Street 1:170 HESTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1025
Mailing Address - Country:US
Mailing Address - Phone:937-823-7608
Mailing Address - Fax:
Practice Address - Street 1:170 HESTON DR
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1025
Practice Address - Country:US
Practice Address - Phone:937-823-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007791.SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional