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LARRY RUBEN BULLARD ASW

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1699116897

Individual Registrant:
 LARRY RUBEN BULLARD ASW
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1350 3RD ST  LA VERNE, CA 91750-5201 US
Tel: 909-596-5921  Fax: 909-596-7583

Contact information for business:
1350 3RD ST  LA VERNE, CA 91750-5201 US
Tel: 909-596-5921  Fax: 909-596-7583

Registration Information:
NPI: 1699116897
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
CAASW35370

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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