Provider Demographics
NPI:1073568085
Name:PULVER, TERRY L (PHD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:PULVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PENN AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2154
Mailing Address - Country:US
Mailing Address - Phone:412-242-4732
Mailing Address - Fax:412-242-4732
Practice Address - Street 1:224 PENN AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2154
Practice Address - Country:US
Practice Address - Phone:412-371-7330
Practice Address - Fax:412-242-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005181L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA620002138OtherRAILROAD MEDICARE
PA128319OtherVALUEOPTIONS
PA435692OtherHIGHMARK BC BS
PA0012547870003Medicaid
PA435692OtherHIGHMARK BC BS
PA435692Medicare ID - Type Unspecified