Provider Demographics
NPI:1578894507
Name:PULTE, COURTNEY BLOOM (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BLOOM
Last Name:PULTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:BLOOM-PULTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:2730 WILSHIRE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4724
Mailing Address - Country:US
Mailing Address - Phone:310-310-2931
Mailing Address - Fax:310-310-2097
Practice Address - Street 1:2730 WILSHIRE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4724
Practice Address - Country:US
Practice Address - Phone:310-310-2931
Practice Address - Fax:310-310-2097
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA1-13-14834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist