Provider Demographics
NPI:1588211510
Name:JUDITH LYNN PULLIAM
Entity Type:Organization
Organization Name:JUDITH LYNN PULLIAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-961-3562
Mailing Address - Street 1:4900 SW GRIFFITH DR STE 235
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4649
Mailing Address - Country:US
Mailing Address - Phone:503-520-9977
Mailing Address - Fax:503-526-3912
Practice Address - Street 1:4900 SW GRIFFITH DR STE 235
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4649
Practice Address - Country:US
Practice Address - Phone:503-520-9977
Practice Address - Fax:503-526-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730208729OtherNPPES