| Gateway Consultation And Counseling Services Llc | |
|
20 Austin St Milton MA 02186-1104 | |
| (781) 843-2555 | |
| (781) 843-9199 |
| Full Name | Gateway Consultation And Counseling Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 20 Austin St, Milton, Massachusetts |
| Authorized Official Name and Position | David P Bullis (OWNER) |
| Authorized Official Contact | 6176808096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Consultation And Counseling Services Llc Po Box 366422 Hyde Park MA 02136-0030 Ph: (781) 843-2555 | Gateway Consultation And Counseling Services Llc 20 Austin St Milton MA 02186-1104 Ph: (781) 843-2555 |
| NPI Number | 1528267291 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 07/15/2024 |
| Certification Date | 07/15/2024 |
| Medicare PECOS PAC ID | 6800988627 |
|---|---|
| Medicare Enrollment ID | O20070824000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528267291 | NPI | - | NPPES |
| W10653 | Other | MA | BLUE CROSS BLUE SHIELD |
| 9758551 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6826 (Massachusetts) | Primary |
| Provider Name | David P Bullis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760445977 PECOS PAC ID: 0042213118 Enrollment ID: I20060809000369 |
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