Katie Bullock, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

106669 Issued in CA

Practice address

5232 Shasta Dam Blvd Ste C
Shasta Lake, CA 96019-9398

Phone

(530) 605-4373

NPI assigned

Sep 9, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Rick Presta, LMFT

  • Community/Behavioral Health Agency
  • Redding, CA
  • NPI 1770984783
  NPD (past)

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1437550498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5232 SHASTA DAM BLVD STE C",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199398",
            "telephone_number": "530-605-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5232 SHASTA DAM BLVD STE C",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199398",
            "telephone_number": "530-605-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "KATIE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-09",
        "last_updated": "2021-05-27",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "106669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katielmft@outlook.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "katielmft@outlook.com",
            "address_1": "5232 Shasta Dam Blvd Ste C",
            "city": "Shasta Lake",
            "state": "CA",
            "country_code": "US",
            "postal_code": "960199398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wayne Bann
• Lauren M Bishop, MED, BCBA
• Larissa N Botcharnikova, PA-C
• Nichole Amber Lee Brandon, LCSW
• Harold S. Budhram, M.D
• Tracy Daniel Campbell, CAS
• Cloe Jay Carpenter
• Cascades Management Company (Ridgeview Residential Center)
• Jeri Rene'E Cates, RN, MSN, FNPC
• Ronald G Chambers I, M.D.

• Marriage & Family Therapist in Shasta Lake, CA
• Providers in Shasta Lake, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.