Provider Demographics
NPI:1770051237
Name:BULL, JENNIFER REID FOSTER (AMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REID FOSTER
Last Name:BULL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JOSEPH CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2609
Mailing Address - Country:US
Mailing Address - Phone:415-492-0720
Mailing Address - Fax:415-492-1099
Practice Address - Street 1:4 JOSEPH CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2609
Practice Address - Country:US
Practice Address - Phone:415-492-0720
Practice Address - Fax:415-492-1099
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist