Provider Demographics
NPI:1356758031
Name:BULLOCK, YENYFER PAHUA (LMFT)
Entity type:Individual
Prefix:
First Name:YENYFER
Middle Name:PAHUA
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S C ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3633
Mailing Address - Country:US
Mailing Address - Phone:714-865-9772
Mailing Address - Fax:
Practice Address - Street 1:300 S C ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3633
Practice Address - Country:US
Practice Address - Phone:714-865-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist