Provider Demographics
NPI:1942310537
Name:PULVER, CHAD ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALLAN
Last Name:PULVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W MILROY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2660
Mailing Address - Country:US
Mailing Address - Phone:219-866-3617
Mailing Address - Fax:219-866-5028
Practice Address - Street 1:420 W MILROY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2660
Practice Address - Country:US
Practice Address - Phone:219-866-3617
Practice Address - Fax:219-866-5028
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042110A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling