Provider Demographics
NPI:1760686281
Name:BULLARD, LISA RENEE (BHRS-CM-CAF)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:BHRS-CM-CAF
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7509 S TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7306
Mailing Address - Country:US
Mailing Address - Phone:918-814-5676
Mailing Address - Fax:918-494-9424
Practice Address - Street 1:2725 E SKELLY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6241
Practice Address - Country:US
Practice Address - Phone:918-382-7300
Practice Address - Fax:918-494-4924
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCERTIFICATE 9760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker