Provider Demographics
NPI:1033498308
Name:BULLER, BONNIE LEJEUNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LEJEUNE
Last Name:BULLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N SERVICE RD E
Mailing Address - Street 2:PMB 184
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2805
Mailing Address - Country:US
Mailing Address - Phone:504-444-2292
Mailing Address - Fax:
Practice Address - Street 1:207 N SERVICE RD E
Practice Address - Street 2:PMB 184
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2805
Practice Address - Country:US
Practice Address - Phone:225-663-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA113871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical