Provider Demographics
NPI:1699223412
Name:BULTMAN, RACHAEL MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:MARIA
Last Name:BULTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 RAVENSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2264
Mailing Address - Country:US
Mailing Address - Phone:616-389-3913
Mailing Address - Fax:
Practice Address - Street 1:1202 RAVENSWOOD DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2264
Practice Address - Country:US
Practice Address - Phone:616-389-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016824103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist