JUDITH LYNN PULLIAM (NPI# 1588211510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588211510 |
| Entity Type | Organization |
| Organization Name | JUDITH LYNN PULLIAM |
| Practice Address |
4900 Sw Griffith Dr Ste 235 Beaverton OR 97005-4649 |
| Practice Telephone | 5035209977 |
| Practice Fax Number | 5035263912 |
| Mailing Telephone | 5035209977 |
| Mailing Fax Number | 5035263912 |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | JUDITH L PULLIAM (PRACTITIONER) |
| Authorized Official Telephone | 5039613562 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPPES | 1730208729 | 01 |
| Street Address |
4900 SW GRIFFITH DR STE 235 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-4649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912298092 | Julie A. Dicks, Ph.d., P.C. | Community/Behavioral Health | 4900 Sw Griffith Dr Ste 235, Beaverton, OR 97005-4649 | 2011-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902260219 | Keri Renee Counseling LLC | Clinic/Center | 10445 Sw Canyon Rd Ste 119b, Beaverton, OR 97005 | 2016-04-12 |
| 1356850697 | Elevate Wellness, LLC | Clinic/Center | 6700 Sw 105th Ave Ste 203, Beaverton, OR 97008-8824 | 2017-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265039564 | Embodied Life Therapy Center LLC | Clinic/Center | 6906 N Richards St, Portland, OR 97203-6138 | 2020-10-08 |
| 1720685696 | Pragmatic Healing LLC | Clinic/Center | 3930 Sw Plum St Apt 1, Portland, OR 97219-6046 | 2020-10-05 |
| 1639793367 | Northwest Geriactrics | Clinic/Center | 10365 Se Sunnyside Rd Ste 340, Clackamas, OR 97015-5751 | 2020-05-28 |
| 1366065872 | Caring Hands Residential Services LLC | Clinic/Center | 16220 Se Mckinley Ave, Clackamas, OR 97015-9418 | 2020-05-19 |
| 1972139947 | Kevin Ryan PC | Clinic/Center | 119 E 2nd St Ste 210, The Dalles, OR 97058-1796 | 2020-03-21 |
| 1083240386 | Peace of Mind Functional Medicine | Clinic/Center | 151 Sw Shevlin Hixon Dr Ste 201, Bend, OR 97702-3233 | 2020-03-18 |
| 1467086215 | Deborah Ann Jewell | Clinic/Center | 5627 Ne Simpson St, Portland, OR 97218-2329 | 2020-03-01 |
| 1154802403 | Dr. Asha Stephen, LLC | Clinic/Center | 1234 Pearl St Ste 7, Eugene, OR 97401-3642 | 2018-08-24 |
| 1891272324 | Cressall Psychiatric LLC | Clinic/Center | 240 E 12th Ave, Eugene, OR 97401-3245 | 2018-07-26 |
| 1174023808 | Blake Locher Counseling, LLC | Clinic/Center | 1020 Sw Taylor St Ste 449, Portland, OR 97205-2556 | 2018-02-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.