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General NPI Number Information
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NPI Number | 1184210791
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Entity Type | Individual
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Provider Name | JOHN H BULTHOUSE JR.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 655 W LINCOLN AVE STE 8
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City | CHARLESTON
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State | IL
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Zip | 61920-2461
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Country | US
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Telephone | 217-254-6582
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Fax |
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Provider Business Mailing Address
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Address Line | 311 W MAIN ST
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City | OAKLAND
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State | IL
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Zip | 61943-7109
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Country | US
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Telephone | 217-512-9178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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