Provider Demographics
NPI:1871045062
Name:PULLETT, TERESA (MS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:PULLETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ASHBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4404
Mailing Address - Country:US
Mailing Address - Phone:267-278-9016
Mailing Address - Fax:
Practice Address - Street 1:12 ASHBRIDGE CT
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4404
Practice Address - Country:US
Practice Address - Phone:267-278-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst