Provider Demographics
NPI:1831438209
Name:PULIS, GEORGE JAMES (MA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JAMES
Last Name:PULIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18870 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-4635
Mailing Address - Country:US
Mailing Address - Phone:707-540-4758
Mailing Address - Fax:707-938-5744
Practice Address - Street 1:3850 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5207
Practice Address - Country:US
Practice Address - Phone:707-546-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 73606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist