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General NPI Number Information
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NPI Number | 1063993038
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Entity Type | Organization
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Legal Business Name | KATHLEEN BULLARD PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 7918 FREDRICKSBURG CT UNIT 101
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City | BRISTOL
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State | WI
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Zip | 53104-8720
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Country | US
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Telephone | 262-806-1467
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Fax | 262-661-7702
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Provider Business Mailing Address
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Address Line | 7918 FREDRICKSBURG CT UNIT 101
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City | BRISTOL
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State | WI
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Zip | 53104-8720
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Country | US
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Telephone | 262-806-1467
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Fax | 262-661-7702
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | KATE M BULLARD
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Credential | MS
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Telephone | 847-809-9218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6363-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16105-131
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License Number State | WI
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