Healthcare Provider Details

I. General information

NPI: 1669572202
Provider Name (Legal Business Name): ELIZABETH PULLIAM PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S WAY # 653
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

1 CHILDREN'S WAY # 653
LITTLE ROCK AR
72202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1100
  • Fax: 501-526-6562
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-526-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06-27P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number06-27P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: