Doctor Name: | MR. BRADFORD LEE BULLARD |
NPI Number: | 1013079995 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LIC PROFESSIONAL COU |
License Number: | 850 |
Business Practice Address: | 187 Belmont Drive Dothan, AL - 36305 |
Business Phone Number: | 3346711280 |
Business Fax Number: | 3346710475 |
Mailing Address: | 187 Belmont Drive, DOTHAN |
State: | AL |
Postal Code: | 36305 |
Phone Number: | 3346711280 |
Fax Number: | 3346710475 |
NPI Enumeration Date: | 12/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 850 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |