| Ryan Bullard, Lcsw | |
|
128 John King Rd Ste 18 Crestview FL 32539-5731 | |
| (850) 347-5457 | |
| (850) 779-3117 |
| Full Name | Ryan Bullard, Lcsw |
|---|---|
| Speciality | Counselor |
| Location | 128 John King Rd Ste 18, Crestview, Florida |
| Authorized Official Name and Position | Ryan Bullard (CEO) |
| Authorized Official Contact | 8503475457 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan Bullard, Lcsw 128 John King Rd Ste 18 Crestview FL 32539-5731 Ph: (850) 347-5457 | Ryan Bullard, Lcsw 128 John King Rd Ste 18 Crestview FL 32539-5731 Ph: (850) 347-5457 |
| NPI Number | 1235707472 |
|---|---|
| Provider Enumeration Date | 06/14/2021 |
| Last Update Date | 03/31/2023 |
| Certification Date | 03/31/2023 |
| Medicare PECOS PAC ID | 0244603660 |
|---|---|
| Medicare Enrollment ID | O20230307000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235707472 | NPI | - | NPPES |
| Provider Name | Ryan Bullard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265072326 PECOS PAC ID: 1153794573 Enrollment ID: I20230307000040 |
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