MEDICARE: CARL A PULEO LPCC

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	174747	KY
2	101YM0800X	Mental Health Counselor	266437	KY

General Provider Information

NPI Number	:	1811400674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL A PULEO LPCC

Provider Business Mailing Address
First Line	:	40 OAK GROVE CHURCH RD
Second Line	:
City	:	PARK CITY
State	:	KY
Zip	:	42160-9377
Country	:	US
Telephone Number	:	270-670-5301
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 OAK GROVE CHURCH RD
Second Line	:
City	:	PARK CITY
State	:	KY
Zip	:	42160-9377
Country	:	US
Telephone Number	:	270-670-5301
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	10/01/2021

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Directions to “ CARL A PULEO LPCC” Practice Location

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