Healthcare Provider Details

I. General information

NPI: 1033037551
Provider Name (Legal Business Name): LUCAS BULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 FRANCIS ST
JACKSON MI
49203-5052
US

IV. Provider business mailing address

158 N GRAND POINTE DR
BROOKLYN MI
49230-9748
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-2551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: