NPIMap

Organization Active NPI

Judith Lynn Pulliam

  • Adult Mental Health Clinic/Center
  • Beaverton, OR
National Provider Identifier
1588211510
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
JUDITH LYNN PULLIAM
Practice address
4900 SW Griffith Dr Ste 235
Beaverton, OR 97005-4649
Phone
(503) 520-9977
Fax
(503) 526-3912
NPI assigned
Aug 23, 2019
Last updated
Oct 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judith L Pulliam, LCSWNPI 1730208729
Title
Practitioner
Phone
(503) 961-3562

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary

Addresses

Primary practice location

4900 SW Griffith Dr Ste 235
Beaverton, OR 97005-4649

Mailing address

4900 SW Griffith Dr Ste 235
Beaverton, OR 97005-4649
Phone (503) 520-9977

Other identifiers 1

IdentifierTypeStateIssuer
1730208729OtherNPPES

National Provider Directory

National Provider Directory

Locations

4900 SW Griffith Dr
Ste 235
Beaverton, OR 97005
Phone (503) 805-9456

8835 SW Canyon Ln
Ste 236
Portland, OR 97225
Phone (503) 961-3562

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1588211510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 SW GRIFFITH DR STE 235",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054649",
            "telephone_number": "503-520-9977",
            "fax_number": "503-526-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 SW GRIFFITH DR STE 235",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054649",
            "telephone_number": "503-520-9977",
            "fax_number": "503-526-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDITH LYNN PULLIAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "PULLIAM",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTITIONER",
        "authorized_official_telephone_number": "503-961-3562",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1730208729",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.