Active NPI
Justin Bullock
- School Counselor
- Philadelphia, PA
National Provider Identifier
1083274161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- Practice address
- 1420 Walnut St Ste 1350
Philadelphia, PA 19102-4019 - Phone
- (215) 664-3200
- NPI assigned
- Jun 19, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| School Counselor | 101YS0200X | Primary |
Addresses
Primary practice location
1420 Walnut St Ste 1350
Philadelphia, PA 19102-4019
Mailing address
2506 Chatham Rd
Lansing, MI 48910-2406
Phone (267) 774-7088
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560902400000",
"number": "1083274161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2506 CHATHAM RD",
"city": "LANSING",
"state": "MI",
"postal_code": "489102406",
"telephone_number": "267-774-7088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 WALNUT ST STE 1350",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191024019",
"telephone_number": "215-664-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-19",
"last_updated": "2019-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.