Basic Information
| Provider Information | |||||||||
| NPI: | 1467819607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PULLEY | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | MONTGOMERY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 YOUREE DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186750804 | ||||||||
| FaxNumber: | 3184259030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 YOUREE DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186750804 | ||||||||
| FaxNumber: | 3184259030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5176 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.