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NPI Code Detail

MEDICARE: STEPHANIE JUDE BULLUSS MS

MEDICARE: STEPHANIE JUDE BULLUSS MS
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
1101YM0800XMental Health Counselor63440MT

General Provider Information

NPI Number : 1639854649
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JUDE BULLUSS MS
Provider Business Mailing Address
First Line : 395 COMFORT LN
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-9139
Country : US
Telephone Number : 406-570-5235
Fax Number :
Provider Business Practice Location Address
First Line : 950 STONERIDGE DR STE 1
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-7063
Country : US
Telephone Number : 406-570-5235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 06/19/2023

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