Provider Demographics
NPI:1619013075
Name:BULTSMA, CRAIG ALAN (MED)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALAN
Last Name:BULTSMA
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BETHANY CHRISTIAN SERVICES
Mailing Address - Street 2:3886 CASS RD.
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-995-0870
Mailing Address - Fax:
Practice Address - Street 1:3886 CASS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8878
Practice Address - Country:US
Practice Address - Phone:231-995-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health