Provider Demographics
NPI:1427540772
Name:PULVER, PAMELA JEAN (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:PULVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-0945
Mailing Address - Country:US
Mailing Address - Phone:206-679-2251
Mailing Address - Fax:
Practice Address - Street 1:46 EADS LN
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-7717
Practice Address - Country:US
Practice Address - Phone:360-378-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60865736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
447750381OtherU.S. PASSPORT
WAPULVERPJ541Q8OtherDRIVER'S LICENSE