Active NPI
Michelle Tullis
- Mental Health Counselor
- Columbia, IL
National Provider Identifier
1083071872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178.011541
- Practice address
- 221 S Metter Ave
Columbia, IL 62236-2253 - Phone
- (618) 420-3353
- NPI assigned
- Jan 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.011541 | IL | Primary |
Addresses
Primary practice location
221 S Metter Ave
Columbia, IL 62236-2253
Mailing address
854 Meadowview LN
Columbia, IL 62236-1012
Phone (618) 420-3353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.011541 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1083071872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "854 MEADOWVIEW LN",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622361012",
"telephone_number": "618-420-3353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 S METTER AVE",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622362253",
"telephone_number": "618-420-3353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLIS",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-25",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.011541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.