Provider Demographics
NPI:1104269414
Name:BULLARD, RHONDA DENISE
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:DENISE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9186 N MACARTHUR BLVD
Mailing Address - Street 2:APT C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2437
Mailing Address - Country:US
Mailing Address - Phone:405-721-3673
Mailing Address - Fax:
Practice Address - Street 1:429 W WILSHIRE BLVD
Practice Address - Street 2:STE. A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7745
Practice Address - Country:US
Practice Address - Phone:405-286-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst