Provider Demographics
NPI:1508106766
Name:PULITZER, AMY (MA, LPC, MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PULITZER
Suffix:
Gender:F
Credentials:MA, LPC, MFT
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 29
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-0029
Mailing Address - Country:US
Mailing Address - Phone:818-212-0091
Mailing Address - Fax:
Practice Address - Street 1:181 LANEDA AVE.
Practice Address - Street 2:
Practice Address - City:MANZANITA
Practice Address - State:OR
Practice Address - Zip Code:97130
Practice Address - Country:US
Practice Address - Phone:503-272-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2941101YM0800X
CA50956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health