Provider Demographics
NPI:1356151880
Name:PULLIAM, TIFFANY JEANETTE (LPC-MHSP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:JEANETTE
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 MACON RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8554
Mailing Address - Country:US
Mailing Address - Phone:901-337-0305
Mailing Address - Fax:901-682-3049
Practice Address - Street 1:8336 MACON RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8554
Practice Address - Country:US
Practice Address - Phone:901-682-3035
Practice Address - Fax:901-682-3049
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional