Active NPI
Teri M Bullis, PH.D.
- Clinical Child & Adolescent Psychologist
- MC Lean, VA
National Provider Identifier
1467670950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 796
- Practice address
- 1319 Vincent PL
MC Lean, VA 22101-3615 - Phone
- (802) 380-1713
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 796 | VT | |
| School Psychologist | 103TS0200X | 796 | VT | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 796 | VT | Primary |
Addresses
Primary practice location
1319 Vincent PL
MC Lean, VA 22101-3615
Mailing address
75 Mount Rd
Cummington, MA 01026-9702
Phone (802) 380-1713
Other practice location 1
83 Sunrise Dr
Guilford, VT 05301-8748
Phone (802) 380-1713
Other names 1
- Dr. Teri M Brooks
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 796 | VT | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677024000000",
"number": "1467670950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 MOUNT RD",
"city": "CUMMINGTON",
"state": "MA",
"postal_code": "010269702",
"telephone_number": "802-380-1713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 VINCENT PL",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221013615",
"telephone_number": "802-380-1713"
}
],
"practiceLocations": [
{
"address_1": "83 Sunrise Dr",
"address_purpose": "LOCATION",
"city": "Guilford",
"state": "VT",
"postal_code": "053018748",
"country_code": "US",
"telephone_number": "802-380-1713",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BULLIS",
"first_name": "TERI",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-23",
"last_updated": "2023-02-22",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "VT",
"license": "796",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "VT",
"license": "796",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "VT",
"license": "796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TERI",
"last_name": "BROOKS",
"middle_name": "M",
"prefix": "DR.",
"credential": "PH.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.