MEDICARE: MRS. LINDA JEAN BULLARD M.S., L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MH10807	FL

General Provider Information

NPI Number	:	1326336108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA JEAN BULLARD M.S., L.M.H.C.

Provider Business Mailing Address
First Line	:	200 E BEACH DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3117
Country	:	US
Telephone Number	:	850-872-4715
Fax Number	:	850-785-6880

Provider Business Practice Location Address
First Line	:	200 E BEACH DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3117
Country	:	US
Telephone Number	:	850-872-4715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	12/04/2014

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