Provider Demographics
NPI:1104047562
Name:BULLARD PSYCHOLOGY CONSULTING, INC.
Entity type:Organization
Organization Name:BULLARD PSYCHOLOGY CONSULTING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GILMORE
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-239-1584
Mailing Address - Street 1:1968 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4811
Mailing Address - Country:US
Mailing Address - Phone:415-239-1584
Mailing Address - Fax:
Practice Address - Street 1:1968 GREEN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4811
Practice Address - Country:US
Practice Address - Phone:415-239-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY4843OtherPSYCHOLOGIST LICENSE