Provider Demographics
NPI:1528342649
Name:PULLEN, JEREMY (LMHC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:PULLEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8408
Mailing Address - Country:US
Mailing Address - Phone:515-408-6218
Mailing Address - Fax:
Practice Address - Street 1:1762 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-8408
Practice Address - Country:US
Practice Address - Phone:515-408-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health