Provider Demographics
NPI:1922365725
Name:BULLARD, VERNEKA EAOSHEA (MSW U/S, LMSW, BA)
Entity Type:Individual
Prefix:MRS
First Name:VERNEKA
Middle Name:EAOSHEA
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MSW U/S, LMSW, BA
Other - Prefix:MS
Other - First Name:VERNEKA
Other - Middle Name:EAOSHEA
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-P, LMSW, BA
Mailing Address - Street 1:4817 SE TATTERSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6431
Mailing Address - Country:US
Mailing Address - Phone:580-647-2006
Mailing Address - Fax:
Practice Address - Street 1:4411 W GORE BLVD
Practice Address - Street 2:SUITE B8
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-695-5596
Practice Address - Fax:580-699-5950
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical