Individual
DR. DANIEL THOMAS BULLARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., BCBA, LBA
Contact information
Practice address
601 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(530) 598-2754
Mailing address
1709 LIBERTY ST, ALTON, IL 62002-4515
(530) 598-2754
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2018045058
MO
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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