| Carla B. Pulliam, Ph.d., P.c. | |
|
315 W Wall St Suite 200 Grapevine TX 76051-5284 | |
| (817) 251-3507 | |
| (817) 251-3507 |
| Full Name | Carla B. Pulliam, Ph.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 315 W Wall St, Grapevine, Texas |
| Authorized Official Name and Position | Carla Battaglia Pulliam (OWNER) |
| Authorized Official Contact | 8172513507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carla B. Pulliam, Ph.d., P.c. 315 W Wall St Suite 200 Grapevine TX 76051-5284 Ph: (817) 251-3507 | Carla B. Pulliam, Ph.d., P.c. 315 W Wall St Suite 200 Grapevine TX 76051-5284 Ph: (817) 251-3507 |
| NPI Number | 1982612198 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 07/31/2008 |
| Medicare PECOS PAC ID | 5597748699 |
|---|---|
| Medicare Enrollment ID | O20040610000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982612198 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 31764 (Texas) | Primary |
| Provider Name | Carla Battaglia Pulliam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972774586 PECOS PAC ID: 4284617390 Enrollment ID: I20040610000338 |
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