Provider Demographics
NPI:1982764460
Name:PULVER PSYCHOLOGICAL SERVIES
Entity type:Organization
Organization Name:PULVER PSYCHOLOGICAL SERVIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:PULVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-866-3617
Mailing Address - Street 1:420 W MILROY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2660
Mailing Address - Country:US
Mailing Address - Phone:219-866-3617
Mailing Address - Fax:
Practice Address - Street 1:420 W MILROY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2660
Practice Address - Country:US
Practice Address - Phone:219-866-3617
Practice Address - Fax:219-866-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty