KAITLIN ELIZABETH TULLY (NPI# 1548455645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548455645 |
| Entity Type | Individual |
| Full Name | KAITLIN ELIZABETH TULLY |
| Credential | PHD |
| Practice Address |
710 S Broadway Suite 300 Walnut Creek CA 94596-5294 |
| Mailing Address |
1425 S Main St Walnut Creek CA 94596-5318 |
| Practice Telephone | 9252954145 |
| Mailing Telephone | 9252954145 |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2014-09-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY26402 | CA | Behavioral Health & Social Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
710 S BROADWAY SUITE 300 |
| City | WALNUT CREEK |
| State | CA |
| Zip Code | 94596-5294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376552836 | Fred K Sondheimer | Specialist | 710 S Broadway, Suite 203, Walnut Creek, CA 94596-5294 | 2006-08-05 |
| 1861009045 | Damari Simon | Behavior Technician | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2020-09-30 |
| 1932716115 | Isabella Blumin | Behavior Technician | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2020-09-30 |
| 1174176937 | Tina Kay Chov | Pharmacist | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2019-07-22 |
| 1124681077 | Nicole Alexandra Torres | Behavior Technician | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2019-04-17 |
| 1508333618 | Jessica Bergstrom | Psychologist | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2018-10-26 |
| 1710463518 | Andrea Secoquian Williams | Behavioral Analyst | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2018-07-14 |
| 1700375599 | Miriam Walter | Psychologist | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2018-05-07 |
| 1134670615 | Amy Beth Cohen | Psychologist | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2016-10-19 |
| 1093168312 | Kaiser Permanente | Health Maintenance Organization | 710 S Broadway, Walnut Creek, CA 94596-5294 | 2016-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467917229 | Alison M Khaddour | Behavior Technician | 800 S Broadway Ste. 310, Walnut Creek, CA 94596 | 2019-02-06 |
| 1134683618 | Ian Colas | Respiratory Therapist, Certified | 1425 South Main Street, Walnut Creek, Walnut Creek, CA 94596 | 2019-01-29 |
| 1912474131 | Albert Dizon Miraflores | Behavior Technician | 1910 Olympic Blvd Walnut Creek Ca 94596, Walnut Creek, CA 94596 | 2018-10-25 |
| 1487136834 | Daryn Stier | Social Worker | 80 Norlyn Drive, Walnut Creek, CA 94596 | 2018-09-02 |
| 1831682335 | Jessica Lim | Registered Nurse | 1357 Oakland Blvd, Walnut Creek, CA 94596 | 2018-06-08 |
| 1699278432 | Alanna Everhart | Behavior Technician | 877 Ygnacio Valley Road, Suite 100, Walnut Creek, CA 94596 | 2018-03-16 |
| 1962958108 | Derek Jue Md | Clinic/Center | 1812 San Miguel Drive, Walnut Creek, CA 94596 | 2016-08-28 |
| 1912369711 | Pamela Jean Lister | Marriage & Family Therapist | 2070 N Broadway, #5370, Walnut Creek, CA 94596 | 2016-03-22 |
| 1548635147 | Anne Lamoreaux Anderson | Behavioral Analyst | 800 South Broadway Suite #310, Walnut Creek, CA 94596 | 2015-12-08 |
| 1346619434 | Christine Anne Gotelli | Registered Nurse | 370 N. Civic Drive #311, San Francico, CA 94596 | 2015-09-18 |
| Find all providers in zip 94596 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225199185 | Robin Beth Fragner | Psychologist | 2950 Camino Diablo Ste 120, Walnut Creek, CA 94597-3979 | 2006-12-13 |
| 1588283741 | Rupa Robbins | Psychologist | 700 Ygnacio Valley Rd Ste 320, Walnut Creek, CA 94596-3838 | 2020-04-08 |
| 1639292139 | Kathryn Rhody Stewart | Psychologist | 3093 Citrus Cir, Suite 170, Walnut Creek, CA 94598-2687 | 2007-04-09 |
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| 1235778614 | Jessica Herbold | Psychologist | 1044 Sir Francis Drake Blvd Ste 7, Kentfield, CA 94904-1454 | 2020-01-02 |
| 1003478405 | Melissa Berrenge-browde | Psychologist | 820 Bay Avenue, Suite 205, Capitola, CA 95010-2102 | 2019-07-05 |
| 1811555840 | Rebecca Cole | Psychologist | 5149 High Meadow Court, Fremont, CA 94536 | 2019-06-04 |
| Find all providers with the same taxonomy | ||||
| City | WALNUT CREEK |
| Zip Code | 94596 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.