Gateway Consultation & Counseling Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6826 Issued in MA

Legal business name

GATEWAY CONSULTATION & COUNSELING SERVICES LLC

Practice address

20 Austin St
Milton, MA 02186-1104

Phone

(781) 843-2555

Fax

(781) 843-9199

NPI assigned

Jul 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David P Bullis, PH.D.NPI 1760445977

Title

Owner

Phone

(617) 680-8096

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Payne Bullis, PHD

  • Clinical Psychologist
  • Boston, MA
  • NPI 1760445977
  Medicare reassignment Authorized official
• Kenneth Abdul-Karim, PH.D.

  • Clinical Psychologist
  • Mashpee, MA
  • NPI 1689850661
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1528267291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366422",
            "city": "HYDE PARK",
            "state": "MA",
            "postal_code": "021360030",
            "telephone_number": "781-843-2555",
            "fax_number": "781-843-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 AUSTIN ST",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "021861104",
            "telephone_number": "781-843-2555",
            "fax_number": "781-843-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY CONSULTATION & COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "BULLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-680-8096",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9758551",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W10653",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julianne Funtsch
• Christopher Gallant, LICSW
• Daniel Gallery, PSYD
• Stacey L Galvin, CRNA
• Melissa L Ganz, RD
• Audrey Gavin
• Gayle M. Pezzulo D.M.D.,P.C.
• John A Geary, PA
• George B McManama Jr MD PC
• George L Barrett, M.D., P.C.

• Clinical Psychologist in Milton, MA
• Providers in Milton, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.