Individual
TANISHA BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3341 YOUREE DR, SHREVEPORT, LA 71105-2149
(318) 219-4364
Mailing address
3341 YOUREE DR, SHREVEPORT, LA 71105-2149
(318) 219-4364
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NA
MS
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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