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General NPI Number Information
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NPI Number | 1467670950
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Entity Type | Individual
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Provider Name | TERI M BULLIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 1319 VINCENT PL
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City | MC LEAN
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State | VA
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Zip | 22101-3615
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Country | US
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Telephone | 802-380-1713
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Fax |
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Provider Business Mailing Address
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Address Line | 75 MOUNT RD
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City | CUMMINGTON
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State | MA
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Zip | 01026-9702
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Country | US
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Telephone | 802-380-1713
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 796
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 796
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 796
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License Number State | VT
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