Provider Demographics
NPI:1407978844
Name:PULLEY, JERRY RAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:RAY
Last Name:PULLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JERRAL
Other - Middle Name:RAY
Other - Last Name:PULLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:28999 OLD TOWN FRONT ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5805
Mailing Address - Country:US
Mailing Address - Phone:951-764-3245
Mailing Address - Fax:951-308-1515
Practice Address - Street 1:28999 OLD TOWN FRONT ST
Practice Address - Street 2:STE. 105
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5805
Practice Address - Country:US
Practice Address - Phone:951-764-3245
Practice Address - Fax:951-308-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 175181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical