Healthcare Provider Details

I. General information

NPI: 1083443485
Provider Name (Legal Business Name): JULIA BULLARD LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 MCCAIN BLVD STE 200
NORTH LITTLE ROCK AR
72116-7612
US

IV. Provider business mailing address

2504 MCCAIN BLVD STE 200
NORTH LITTLE ROCK AR
72116-7612
US

V. Phone/Fax

Practice location:
  • Phone: 501-781-2230
  • Fax:
Mailing address:
  • Phone: 501-781-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2407011
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2407011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: