Provider Demographics
NPI:1972621878
Name:PULLEY VANBUREN, KIMBERLY DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:PULLEY VANBUREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DUNTHORTE LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3241
Mailing Address - Country:US
Mailing Address - Phone:210-326-5292
Mailing Address - Fax:210-326-5292
Practice Address - Street 1:3 DUNTHORTE LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-3241
Practice Address - Country:US
Practice Address - Phone:210-326-5292
Practice Address - Fax:210-326-5292
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
TX201372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner