Basic Information
| Provider Information | |||||||||
| NPI: | 1649330648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3491 SHADYWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481449687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348566074 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8765 LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPERANCE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481829583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348473802 | ||||||||
| FaxNumber: | 7348473418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | PB057393 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.