Provider Demographics
NPI:1124551866
Name:BULL, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 O ST
Mailing Address - Street 2:6
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6159
Mailing Address - Country:US
Mailing Address - Phone:916-410-5974
Mailing Address - Fax:
Practice Address - Street 1:3031 C ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3326
Practice Address - Country:US
Practice Address - Phone:916-442-2396
Practice Address - Fax:916-442-2525
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician