Provider Demographics
NPI:1780801522
Name:BULL, DWIGHT EVAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:EVAN
Last Name:BULL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E BARTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-8576
Mailing Address - Country:US
Mailing Address - Phone:231-652-1370
Mailing Address - Fax:
Practice Address - Street 1:10495 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-8740
Practice Address - Country:US
Practice Address - Phone:231-652-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010335791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical