| Paquita R Pullen, Llc | |
|
110 Glancy St Ste 203 Goodlettsville TN 37072-2313 | |
| (615) 424-7908 | |
| Not Available |
| Full Name | Paquita R Pullen, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 110 Glancy St Ste 203, Goodlettsville, Tennessee |
| Authorized Official Name and Position | Paquita R Pullen (OWNER/CEO) |
| Authorized Official Contact | 6154247908 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Paquita R Pullen, Llc 110 Glancy St Ste 203 Goodlettsville TN 37072-2313 Ph: (615) 424-7908 | Paquita R Pullen, Llc 110 Glancy St Ste 203 Goodlettsville TN 37072-2313 Ph: (615) 424-7908 |
| NPI Number | 1518587690 |
|---|---|
| Provider Enumeration Date | 04/20/2020 |
| Last Update Date | 04/23/2020 |
| Certification Date | 04/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518587690 | NPI | - | NPPES |
| 146773351 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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