1851816490 NPI number — MRS. JOHANNA PULE LCSW

Table of content: MRS. JOHANNA PULE LCSW (NPI 1851816490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851816490 NPI number — MRS. JOHANNA PULE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PULE
Provider First Name:
JOHANNA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851816490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10711 MOONLIGHT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77096-6223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-968-6944
Provider Business Mailing Address Fax Number:
361-298-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 FANNIN ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-325-7331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  53163 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 378458903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".