Provider Demographics
NPI:1609135136
Name:BULEMORE, BRIAN JOHN (LPC, NCC, CADC-III)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOHN
Last Name:BULEMORE
Suffix:
Gender:M
Credentials:LPC, NCC, CADC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1736
Mailing Address - Country:US
Mailing Address - Phone:541-639-4499
Mailing Address - Fax:888-770-8838
Practice Address - Street 1:115 NW OREGON AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2741
Practice Address - Country:US
Practice Address - Phone:541-639-4499
Practice Address - Fax:888-770-8838
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-03-61101YA0400X
ORC1953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)