Provider Demographics
NPI:1962650598
Name:PULLEN, AMY DAWNELL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DAWNELL
Last Name:PULLEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NW 23RD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3209
Mailing Address - Country:US
Mailing Address - Phone:503-247-8000
Mailing Address - Fax:
Practice Address - Street 1:604 NW 23RD AVE STE 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3209
Practice Address - Country:US
Practice Address - Phone:503-247-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health