=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740825033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSIE PULLIAM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2019
-----------------------------------------------------
Last Update Date | 01/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 CAPELL VALLEY RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-9151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-227-1163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 132
-----------------------------------------------------
City | SAINT HELENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94574-0132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 34395
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------