Provider Demographics
NPI:1093376766
Name:PULLEN-UMHRA, NICOLE DENISE (LMFTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:PULLEN-UMHRA
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST STE 30-08
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-9123
Mailing Address - Country:US
Mailing Address - Phone:253-301-4983
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 30-08
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-9123
Practice Address - Country:US
Practice Address - Phone:253-301-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60956276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist