Provider Demographics
NPI:1720433873
Name:PULLEN, NATHAN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:PULLEN
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 S 1ST ST
Mailing Address - Street 2:1522
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6870
Mailing Address - Country:US
Mailing Address - Phone:956-566-2757
Mailing Address - Fax:
Practice Address - Street 1:13405 SADDLE BACK PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6149
Practice Address - Country:US
Practice Address - Phone:956-566-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-17419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst