Provider Demographics
NPI:1891558136
Name:PULLIAM, JAMIE (BT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 SE BELMONT ST APT 428
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2479
Mailing Address - Country:US
Mailing Address - Phone:503-422-2596
Mailing Address - Fax:
Practice Address - Street 1:11126 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2021
Practice Address - Country:US
Practice Address - Phone:503-516-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10237970106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician