Individual provider · NPI-1

Ryan Bullard, LCSW, BCD, PMH-C

Social Worker, Clinical · Crestview, FL

NPI number1265072326
StatusActive
Last updated in NPPESFeb 26, 2023

Details

NPI
1265072326
Entity type
Individual (NPI-1)
Name
Mr. Ryan Bullard
Credential
LCSW, BCD, PMH-C
Sex
Male
Sole proprietor
No
Enumeration date
Jan 7, 2020
Certification date
Feb 26, 2023
Last updated
Feb 26, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, ClinicalSW16948–Yes
101YA0400X Counselor, Addiction (Substance Use Disorder)–FL
101YM0800X Counselor, Mental Health––
1041S0200X Social Worker, SchoolSW16948–

Practice location

128 John King Rd Ste 18
Crestview, FL 32539-5731

Phone 850-347-5457 · Fax 850-779-3117

Mailing address

128 John King Rd Ste 18
Crestview, FL 32539-5731

Phone 850-347-5457 · Fax 850-779-3117

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