Provider Demographics
NPI:1912332107
Name:TULLY, LAURA MAGDALEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MAGDALEN
Last Name:TULLY
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 1:4701 X ST
Mailing Address - Street 2:UC DAVIS IMAGING RESEARCH CENTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2219
Mailing Address - Country:US
Mailing Address - Phone:916-734-7927
Mailing Address - Fax:
Practice Address - Street 1:4701 X ST
Practice Address - Street 2:UC DAVIS IMAGING RESEARCH CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2219
Practice Address - Country:US
Practice Address - Phone:916-734-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10300000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist