Provider Demographics
NPI:1275616047
Name:PULLIN, DOUGLAS WINDSOR (MSW, MA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WINDSOR
Last Name:PULLIN
Suffix:
Gender:M
Credentials:MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18891 WALLING CIR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1717
Mailing Address - Country:US
Mailing Address - Phone:503-913-2917
Mailing Address - Fax:
Practice Address - Street 1:2311 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1655
Practice Address - Country:US
Practice Address - Phone:503-293-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical