MEDICARE: CARRIE PULLIE MS, NCC, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	57205
2	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1548387236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE PULLIE MS, NCC, LCPC

Provider Business Mailing Address
First Line	:	235 E 103RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2807
Country	:	US
Telephone Number	:	773-371-3667
Fax Number	:	773-371-3699

Provider Business Practice Location Address
First Line	:	235 E 103RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2807
Country	:	US
Telephone Number	:	773-371-3667
Fax Number	:	773-371-3699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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