MEDICARE: NICOLE DENISE PULLEN-UMHRA LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MG60956276	WA

General Provider Information

NPI Number	:	1093376766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DENISE PULLEN-UMHRA LMFTA

Provider Business Mailing Address
First Line	:	4301 S PINE ST STE 30-08
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-9123
Country	:	US
Telephone Number	:	253-301-4983
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 S PINE ST STE 30-08
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-9123
Country	:	US
Telephone Number	:	253-301-4983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	09/14/2021

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