Active NPI
Tahlany Gullens, MSW
- Behavior Technician
- South Bend, IN
National Provider Identifier
1194413047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB1099799
- Practice address
- 2505 E Jefferson Blvd
South Bend, IN 46615-2635 - Phone
- (574) 289-4831
- NPI assigned
- Apr 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB1099799 | IN | Primary |
| Social Worker | 104100000X | 33010975A | IN |
Addresses
Primary practice location
2505 E Jefferson Blvd
South Bend, IN 46615-2635
Mailing address
2505 E Jefferson Blvd
South Bend, IN 46615-2635
Phone (574) 289-4831
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 |
|---|---|---|---|
| 33010975A | IN | MD | Social Worker |
| BACB1099799 | IN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714694400000",
"number": "1194413047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2505 E JEFFERSON BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466152635",
"telephone_number": "574-289-4831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 E JEFFERSON BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466152635",
"telephone_number": "574-289-4831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLENS",
"first_name": "TAHLANY",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-28",
"last_updated": "2024-05-03",
"certification_date": "2024-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "BACB1099799",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33010975A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.