Provider Demographics
NPI:1306357553
Name:BULLEMER, JOAN FRANCES (MA, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:FRANCES
Last Name:BULLEMER
Suffix:
Gender:F
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 CHATHAM RD NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3302
Mailing Address - Country:US
Mailing Address - Phone:612-267-1949
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 134
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3049
Practice Address - Country:US
Practice Address - Phone:612-267-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301813101YA0400X
MN02027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)