Selah R Bullock

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

900 Branchview Dr NE Ste 200
Concord, NC 28025-2226

Phone

(704) 780-4271

Fax

(888) 261-6694

NPI assigned

Mar 9, 2022

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": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1366199374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BRANCHVIEW DR NE STE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252226",
            "telephone_number": "704-780-4271",
            "fax_number": "888-261-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BRANCHVIEW DR NE STE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252226",
            "telephone_number": "704-780-4271",
            "fax_number": "888-261-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "SELAH",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Michael Buddendeck, DDS
• Joelle Buitendorp
• Sean Michael Buitendorp, DPT
• Alicia Marie Bullock, LCSWA, LCASA
• Brittany Rae Bullock, PHARMD
• Betsy J Bumbarger, ATC L
• Jennifer B. Bunch, DO
• Ryan Thomas Bunch, DO
• Sarah Marjorie Burch, DO
• Shelby Burchett

• All providers in Concord, NC
• Behavior Technician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.