Provider Demographics
NPI:1821509761
Name:BULLARD, JASON RAY (MSW, LCSW, C-SSWS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RAY
Last Name:BULLARD
Suffix:
Gender:M
Credentials:MSW, LCSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 JENNIFER CT
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5943
Mailing Address - Country:US
Mailing Address - Phone:317-726-6526
Mailing Address - Fax:
Practice Address - Street 1:3209 JENNIFER CT
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5943
Practice Address - Country:US
Practice Address - Phone:317-726-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA125861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical