Provider Demographics
NPI:1285204289
Name:BULTHUIS, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BULTHUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SUSAN CIR
Mailing Address - Street 2:
Mailing Address - City:DRUMMONDS
Mailing Address - State:TN
Mailing Address - Zip Code:38023-6843
Mailing Address - Country:US
Mailing Address - Phone:847-505-9850
Mailing Address - Fax:
Practice Address - Street 1:226 MCCORD HALL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3330
Practice Address - Country:US
Practice Address - Phone:847-505-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker