Provider Demographics
NPI:1083983373
Name:BULLARD, AMBER R (MFT-INTERN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:R
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5121 STOCKDALE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2656
Mailing Address - Country:US
Mailing Address - Phone:661-868-5073
Mailing Address - Fax:
Practice Address - Street 1:5121 STOCKDALE HWY STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2656
Practice Address - Country:US
Practice Address - Phone:661-868-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA72271390200000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program