Provider Demographics
NPI:1891853750
Name:BECKER PULLMAN, MELODY DEANNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:DEANNE
Last Name:BECKER PULLMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1332
Mailing Address - Country:US
Mailing Address - Phone:712-737-2635
Mailing Address - Fax:712-737-2344
Practice Address - Street 1:400 CENTRAL AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1332
Practice Address - Country:US
Practice Address - Phone:712-737-2635
Practice Address - Fax:712-737-2344
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2204101YM0800X
SDLPC994101YP2500X
IA083831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA083831OtherSTATE LICENSE