Provider Demographics
NPI:1972774586
Name:PULLIAM, CARLA BATTAGLIA (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:BATTAGLIA
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W WALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5284
Mailing Address - Country:US
Mailing Address - Phone:817-251-3507
Mailing Address - Fax:
Practice Address - Street 1:315 W WALL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5284
Practice Address - Country:US
Practice Address - Phone:817-251-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8212Medicare PIN