Active NPI
Thada Pulliam, LPC
- Professional Counselor
- Blue Springs, MO
National Provider Identifier
1396875787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1999136662
- Practice address
- 1209 NW R Idge Dr.
C
Blue Springs, MO 64015 - Phone
- (816) 229-8080
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1999136662 | MO | Primary |
Addresses
Primary practice location
1209 NW R Idge Dr.
C
Blue Springs, MO 64015
Mailing address
619 NE Bordner Dr
Lees Summit, MO 64086-6228
Phone (816) 554-1415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1999136662 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1396875787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 NE BORDNER DR",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640866228",
"telephone_number": "816-554-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 NW R IDGE DR.",
"address_2": "C",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "64015",
"telephone_number": "816-229-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULLIAM",
"first_name": "THADA",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "1999136662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.