Provider Demographics
NPI:1831625664
Name:PULLIAM, FANCI RAE (LCPC)
Entity type:Individual
Prefix:
First Name:FANCI
Middle Name:RAE
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:FANCI
Other - Middle Name:RAE
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-761-2100
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:1800 19TH AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/SUNNYSIDE
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-6130
Practice Address - Country:US
Practice Address - Phone:406-761-2100
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health