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General NPI Number Information
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NPI Number | 1497064745
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Entity Type | Organization
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Legal Business Name | JENNIFER E BULLARD MA, LPC, PC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 1751 BROAD PARK CIR S SUITE 207
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City | MANSFIELD
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State | TX
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Zip | 76063-7826
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Country | US
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Telephone | 817-291-4564
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Fax | 817-473-7787
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Provider Business Mailing Address
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Address Line | 5554 AMISTAD ST
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City | FORT WORTH
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State | TX
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Zip | 76137-5365
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Country | US
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Telephone | 817-291-4564
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Fax | 817-473-7787
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JENNIFER E BULLARD
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Credential | MA, LPC-S
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Telephone | 817-291-4564
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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 | 17244
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License Number State | TX
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