MEDICARE: MS. JENNIFER E BULLARD MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	17244	TX

General Provider Information

NPI Number	:	1437479193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER E BULLARD MA, LPC

Provider Business Mailing Address
First Line	:	1751 BROAD PARK CIR S
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7826
Country	:	US
Telephone Number	:	817-291-3843
Fax Number	:	817-473-7787

Provider Business Practice Location Address
First Line	:	5554 AMISTAD ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5365
Country	:	US
Telephone Number	:	817-291-3843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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