Provider Demographics
NPI:1861065765
Name:PULLAM, ESSICA (LPC)
Entity type:Individual
Prefix:
First Name:ESSICA
Middle Name:
Last Name:PULLAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HIGHWAY 287 N STE 106
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2643
Mailing Address - Country:US
Mailing Address - Phone:214-702-1518
Mailing Address - Fax:
Practice Address - Street 1:2363 U.S. 287 FRONTAGE RD
Practice Address - Street 2:210
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:214-702-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
TX79451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251B00000XAgenciesCase Management