Provider Demographics
NPI:1427165133
Name:WULBERT, JOYCE (LMSW ACP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:WULBERT
Suffix:
Gender:F
Credentials:LMSW ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 N COLLINS BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3613
Mailing Address - Country:US
Mailing Address - Phone:214-369-5522
Mailing Address - Fax:214-369-5327
Practice Address - Street 1:1755 N COLLINS BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3613
Practice Address - Country:US
Practice Address - Phone:214-369-5522
Practice Address - Fax:214-369-5327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS035921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100585202Medicaid
TX00S40JMedicare PIN
TX100585202Medicaid