Provider Demographics
NPI:1588445464
Name:PULLIAM, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3127
Mailing Address - Country:US
Mailing Address - Phone:610-283-3268
Mailing Address - Fax:
Practice Address - Street 1:699 WOOLTOWN RD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9515
Practice Address - Country:US
Practice Address - Phone:717-917-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor