Individual
MRS. JESSICA MICHELLE BULTHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LCPC
Contact information
Practice address
304 8TH ST, CHARLESTON, IL 61920-1504
(217) 508-7415
Mailing address
311 W MAIN ST, OAKLAND, IL 61943-7109
(217) 508-7415
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.008309
IL
101YP2500X
Professional Counselor
Primary
180009706
IL
Other
Enumeration date
09/07/2012
Last updated
05/18/2015
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