Healthcare Provider Details

I. General information

NPI: 1811695737
Provider Name (Legal Business Name): PULLMAN BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S GRAND AVE STE A
PULLMAN WA
99163-2712
US

IV. Provider business mailing address

405 S GRAND AVE STE A
PULLMAN WA
99163-2712
US

V. Phone/Fax

Practice location:
  • Phone: 661-496-7367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN CAFFREY
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 509-339-6401