Provider Demographics
NPI:1952127391
Name:PULS, KELLIE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:PULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 TRACIE DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2412
Mailing Address - Country:US
Mailing Address - Phone:714-313-6574
Mailing Address - Fax:
Practice Address - Street 1:27240 TURNBERRY LN STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1045
Practice Address - Country:US
Practice Address - Phone:661-403-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC8351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional