=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982612198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLA B. PULLIAM, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W WALL ST SUITE 200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-5284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-3507
-----------------------------------------------------
Fax | 817-251-3507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W WALL ST SUITE 200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-5284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-3507
-----------------------------------------------------
Fax | 817-251-3507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CARLA BATTAGLIA PULLIAM
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 817-251-3507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 31764
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------