Healthcare Provider Details

I. General information

NPI: 1003383860
Provider Name (Legal Business Name): NANCY PULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 18TH ST STE 104
SAN FRANCISCO CA
94114-2449
US

IV. Provider business mailing address

4200 18TH ST STE 104
SAN FRANCISCO CA
94114-2449
US

V. Phone/Fax

Practice location:
  • Phone: 415-569-6304
  • Fax:
Mailing address:
  • Phone: 415-569-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number153734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: