Provider Demographics
NPI:1801563556
Name:BULLARD, JEREMIAH
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14892 N US HIGHWAY 25 E STE 3
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-6190
Mailing Address - Country:US
Mailing Address - Phone:606-526-9348
Mailing Address - Fax:606-385-1853
Practice Address - Street 1:14892 N US HIGHWAY 25 E STE 3
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6190
Practice Address - Country:US
Practice Address - Phone:606-526-9348
Practice Address - Fax:606-385-1853
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)