Tiawana Bullock III

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

555 Northgate Dr
Family Service Agency of Marin
San Rafael, CA 94903

Phone

(415) 491-5700

Fax

(415) 491-5750

NPI assigned

Feb 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306985502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 NORTHGATE DR",
            "address_2": "FAMILY SERVICE AGENCY OF MARIN",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-491-5700",
            "fax_number": "415-491-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 NORTHGATE DR",
            "address_2": "FAMILY SERVICE AGENCY OF MARIN",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-491-5700",
            "fax_number": "415-491-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "TIAWANA",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Huong Le Bui
• Trini Bui
• Vincent L Bulanan
• Jennifer Reid Foster Bull, AMFT
• Michelle Diane Bullard
• Laurie Elizabeth Buntain, MFT
• Sharon Burchik
• Tanya G Burdick, MSPT
• Marne Anne Burgess, FNP
• Reuben Burke

• Counselor in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Counselor in California

• 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.

Verify at the official NPI Registry.