Healthcare Provider Details

I. General information

NPI: 1972201747
Provider Name (Legal Business Name): CYNTHIA D BULLARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7958 HIGHWAY 79 S
PINE BLUFF AR
71603-4541
US

IV. Provider business mailing address

PO BOX 1251
PINE BLUFF AR
71613-1251
US

V. Phone/Fax

Practice location:
  • Phone: 870-489-5454
  • Fax:
Mailing address:
  • Phone: 870-489-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2408025
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number112061
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2408025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: