Active NPI
Mary Blake Bulla, LMHC
- Mental Health Counselor
- Sunrise, FL
National Provider Identifier
1932739638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 17676
- Practice address
- 240 Riverwalk Cir
Sunrise, FL 33326-2291 - Phone
- (954) 770-1175
- NPI assigned
- Jan 22, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 17676 | FL | Primary |
Addresses
Primary practice location
240 Riverwalk Cir
Sunrise, FL 33326-2291
Mailing address
240 Riverwalk Cir
Sunrise, FL 33326-2291
Phone (954) 770-1175
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17676 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1932739638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 RIVERWALK CIR",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333262291",
"telephone_number": "954-770-1175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 RIVERWALK CIR",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333262291",
"telephone_number": "954-770-1175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLA",
"first_name": "MARY BLAKE",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "17676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.