Provider Demographics
NPI:1275894917
Name:BULLARD-MOORE, ETHEL JOY RATHER (MT-BC, RYT, LPC)
Entity Type:Individual
Prefix:
First Name:ETHEL JOY
Middle Name:RATHER
Last Name:BULLARD-MOORE
Suffix:
Gender:F
Credentials:MT-BC, RYT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1910
Mailing Address - Country:US
Mailing Address - Phone:786-458-8678
Mailing Address - Fax:
Practice Address - Street 1:141 W 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1910
Practice Address - Country:US
Practice Address - Phone:786-458-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional