Healthcare Provider Details

I. General information

NPI: 1093204430
Provider Name (Legal Business Name): JESSICA BULGIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S ST
SACRAMENTO CA
95811-6919
US

IV. Provider business mailing address

401 S ST
SACRAMENTO CA
95811-6919
US

V. Phone/Fax

Practice location:
  • Phone: 916-584-7800
  • Fax:
Mailing address:
  • Phone: 916-584-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2002765
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: