Provider Demographics
NPI:1457635583
Name:PULLEN AND PULLEN
Entity Type:Organization
Organization Name:PULLEN AND PULLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-408-6218
Mailing Address - Street 1:1762 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8408
Mailing Address - Country:US
Mailing Address - Phone:515-408-6218
Mailing Address - Fax:
Practice Address - Street 1:1762 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-8408
Practice Address - Country:US
Practice Address - Phone:515-408-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001322101YM0800X
IA001209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty