Provider Demographics
NPI:1124820733
Name:ULMER, DUSTIN ABE
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ABE
Last Name:ULMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S 21ST ST APT 325
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3480
Mailing Address - Country:US
Mailing Address - Phone:254-400-9309
Mailing Address - Fax:
Practice Address - Street 1:15140 BADGER RANCH BLVD
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-8983
Practice Address - Country:US
Practice Address - Phone:254-545-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician