Provider Demographics
NPI:1144351297
Name:BULL, STEPHEN M (MDIV, MSW/LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:BULL
Suffix:
Gender:M
Credentials:MDIV, MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W B ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1121
Mailing Address - Country:US
Mailing Address - Phone:541-501-7336
Mailing Address - Fax:
Practice Address - Street 1:240 N EGAN AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1732
Practice Address - Country:US
Practice Address - Phone:541-501-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR41441041C0700X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist