Provider Demographics
NPI:1639854649
Name:BULLUSS, STEPHANIE JUDE (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUDE
Last Name:BULLUSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 COMFORT LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9139
Mailing Address - Country:US
Mailing Address - Phone:406-570-5235
Mailing Address - Fax:
Practice Address - Street 1:950 STONERIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7063
Practice Address - Country:US
Practice Address - Phone:406-570-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT63440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health