Provider Demographics
NPI:1710114095
Name:PULLIAM, ELISHIA L II (MS, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ELISHIA
Middle Name:L
Last Name:PULLIAM
Suffix:II
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3319 N 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3919
Mailing Address - Country:US
Mailing Address - Phone:414-349-0135
Mailing Address - Fax:414-873-4021
Practice Address - Street 1:1720 W FLORIST AVE STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3800
Practice Address - Country:US
Practice Address - Phone:414-247-0801
Practice Address - Fax:414-247-0816
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI503-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional