Doctor Name: | MISS FLORTASHA LARAY PULLOM |
NPI Number: | 1043559529 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | |
Business Practice Address: | 4101 Ne Division St Suite 100 Gresham, OR - 970304617 |
Business Phone Number: | 5036663808 |
Business Fax Number: | 5036666835 |
Mailing Address: | 4101 Ne Division St, Suite 100 GRESHAM |
State: | OR |
Postal Code: | 970304617 |
Phone Number: | 5036663808 |
Fax Number: | 5036666835 |
NPI Enumeration Date: | 02/04/2013 |
NPI Last Update Date: | 02/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |