Provider Demographics
NPI:1407324130
Name:BULLARD, WENDY LOVE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LOVE
Last Name:BULLARD
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 1:1617 FOUNTAIN VIEW DR APT 193
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2452
Mailing Address - Country:US
Mailing Address - Phone:903-746-3449
Mailing Address - Fax:
Practice Address - Street 1:3926 BAHLER AVE
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2823
Practice Address - Country:US
Practice Address - Phone:281-489-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional