Provider Demographics
NPI:1942734991
Name:BULLER, MARITZA YVETTE NAVARRO (LPC)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:YVETTE NAVARRO
Last Name:BULLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 EXCHANGE PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2510
Mailing Address - Country:US
Mailing Address - Phone:337-242-7307
Mailing Address - Fax:337-345-1576
Practice Address - Street 1:118 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2510
Practice Address - Country:US
Practice Address - Phone:337-242-7307
Practice Address - Fax:337-345-1576
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health