MEDICARE: TONYA MICHELLE GRIFFITH-BULLARD

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	175T00000X	Peer Specialist		OH

General Provider Information

NPI Number	:	1639974207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA MICHELLE GRIFFITH-BULLARD

Provider Business Mailing Address
First Line	:	PO BOX 5102
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-0102
Country	:	US
Telephone Number	:	216-600-6245
Fax Number	:

Provider Business Practice Location Address
First Line	:	7305 CARSON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4127
Country	:	US
Telephone Number	:	216-600-6245
Fax Number	:

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

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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