Provider Demographics
NPI:1952049447
Name:BULLARD, MACY CHEYANNE
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:CHEYANNE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESTWIND DR STE 403
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3032
Mailing Address - Country:US
Mailing Address - Phone:916-365-6285
Mailing Address - Fax:
Practice Address - Street 1:4120 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4982
Practice Address - Country:US
Practice Address - Phone:661-599-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician