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General NPI Number Information
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NPI Number | 1215937313
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Entity Type | Individual
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Provider Name | BARRY W BULLARD PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1902 GALLERIA OAKS DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4619
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Country | US
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Telephone | 903-614-3800
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Fax | 903-792-1504
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Provider Business Mailing Address
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Address Line | 5002 COWHORN CREEK RD
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City | TEXARKANA
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State | TX
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Zip | 75503-9766
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Country | US
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Telephone | 903-614-3000
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Fax | 903-614-3525
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | R56487
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License Number State | TX
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