Active NPI
Bradford Lee Bullard, LIC PROFESSIONAL COU
- Professional Counselor
- Dothan, AL
National Provider Identifier
1013079995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 850
- Practice address
- 187 Belmont Drive
Dothan, AL 36305 - Phone
- (334) 671-1280
- Fax
- (334) 671-0475
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 850 | AL | Primary |
Addresses
Primary practice location
187 Belmont Drive
Dothan, AL 36305
Mailing address
187 Belmont Drive
Dothan, AL 36305
Phone (334) 671-1280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 850 | AL | MD | Clinical Psychologist |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ECABAA/Endpoint/ECABAA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013079995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "187 BELMONT DRIVE",
"city": "DOTHAN",
"state": "AL",
"postal_code": "36305",
"telephone_number": "334-671-1280",
"fax_number": "334-671-0475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 BELMONT DRIVE",
"city": "DOTHAN",
"state": "AL",
"postal_code": "36305",
"telephone_number": "334-671-1280",
"fax_number": "334-671-0475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARD",
"first_name": "BRADFORD",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "LIC PROFESSIONAL COU",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AL",
"license": "850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.