MEDICARE: JEREMIAH BULLARD LPCA

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	304165	KY

General Provider Information

NPI Number	:	1801563556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH BULLARD LPCA

Provider Business Mailing Address
First Line	:	113 BARTON MILL RD APT 2H
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2921
Country	:	US
Telephone Number	:	606-627-3595
Fax Number	:	606-385-1853

Provider Business Practice Location Address
First Line	:	113 BARTON MILL RD APT 2H
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2921
Country	:	US
Telephone Number	:	606-627-3595
Fax Number	:	606-385-1853

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	04/17/2026

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Directions to “ JEREMIAH BULLARD LPCA” Practice Location

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