Provider Demographics
NPI:1053862144
Name:TARULLO, DAVID (LCADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TARULLO
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 INDIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1751
Mailing Address - Country:US
Mailing Address - Phone:502-618-6088
Mailing Address - Fax:
Practice Address - Street 1:1230 S HURSTBOURNE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5757
Practice Address - Country:US
Practice Address - Phone:502-276-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)