Provider Demographics
NPI:1861977167
Name:BULLARD, JOHN JOSEPH (RBT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:BULLARD
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0259
Mailing Address - Country:US
Mailing Address - Phone:850-865-4151
Mailing Address - Fax:850-362-6826
Practice Address - Street 1:417 RACETRACK RD NW STE C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4612
Practice Address - Country:US
Practice Address - Phone:850-362-6824
Practice Address - Fax:850-362-6826
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst