Provider Demographics
NPI:1669626453
Name:PULLIAM, SHEREE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SHEREE
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15095 AMARGOSA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1868
Mailing Address - Country:US
Mailing Address - Phone:760-245-4695
Mailing Address - Fax:760-513-4696
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1868
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-513-4696
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist