Provider Demographics
NPI:1700069440
Name:PULLEN, NANCY CONANT (PHD MS RN LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CONANT
Last Name:PULLEN
Suffix:
Gender:F
Credentials:PHD MS RN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E OLIN AVE
Mailing Address - Street 2:SUITE #220 - PSYCHOLOGY ASSOCIATES
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1487
Mailing Address - Country:US
Mailing Address - Phone:608-255-9119
Mailing Address - Fax:608-255-9219
Practice Address - Street 1:122 E OLIN AVE
Practice Address - Street 2:SUITE #220 - PSYCHOLOGY ASSOCIATES
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1487
Practice Address - Country:US
Practice Address - Phone:608-255-9119
Practice Address - Fax:608-255-9219
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3909497080Medicaid