Provider Demographics
NPI:1578767703
Name:TULLOCK, MICHELLE L (LCSW, MCAP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:TULLOCK
Suffix:
Gender:F
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N UNIVERSITY DR STE 350
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6000
Mailing Address - Country:US
Mailing Address - Phone:954-227-2700
Mailing Address - Fax:954-227-2704
Practice Address - Street 1:1725 N UNIVERSITY DR STE 350
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6000
Practice Address - Country:US
Practice Address - Phone:954-227-2700
Practice Address - Fax:954-227-2704
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical