Lance Everett Bullock

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

09761R Issued in LA

Practice address

3136 S Saint Landry Ave
Gonzales, LA 70737-5801

Phone

(225) 647-7524

NPI assigned

Jul 11, 2007

Last updated

May 21, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jefferson Parish Human Services Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jefferson, LA
  • NPI 1043258007
  NPD (past)
• Jefferson Parish Human Services Authority

  dba Jefferson Parish Human Services Authority-Elmwood

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jefferson, LA
  • NPI 1194252478
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242864000000",
    "number": "1225236235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37459 ULTIMA PLAZA BLVD STE B-227",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707693856",
            "telephone_number": "225-673-8258",
            "fax_number": "225-673-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 S SAINT LANDRY AVE",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375801",
            "telephone_number": "225-647-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "LANCE",
        "middle_name": "EVERETT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-11",
        "last_updated": "2009-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "09761R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1683728",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tim Brown, RPH
• Kevin L. Buckels
• Mitzi Buckman, FNP-C
• Cameron Bueche
• Tracy Mai Bui
• Quenterra Burd
• Lashawnda Burks, LCSW-BACS
• La'Quesha J Butler, LPC
• Nicole Gaudet Buuck
• Byron Robert Rome Apdc

• Psychiatry Physician in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.