Provider Demographics
NPI:1679354047
Name:BULLAND, CELISE RAELYNN (MHC)
Entity Type:Individual
Prefix:
First Name:CELISE
Middle Name:RAELYNN
Last Name:BULLAND
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:CELISE
Other - Middle Name:RAELYNN
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 E SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4550
Mailing Address - Country:US
Mailing Address - Phone:641-351-4003
Mailing Address - Fax:
Practice Address - Street 1:15 E SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4550
Practice Address - Country:US
Practice Address - Phone:641-351-4003
Practice Address - Fax:641-351-4003
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health