Individual
TARA A BULKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC
Contact information
Practice address
5340 HOLIDAY TER, KALAMAZOO, MI 49009-2196
(269) 372-4140
Mailing address
6626 ROTHBURY ST, PORTAGE, MI 49024-3145
(269) 352-5684
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401224519
MI
101Y00000X
Counselor
6451022318
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401224519
LARA
MI
01
—
6451022318
LARA
MI
Enumeration date
07/07/2022
Last updated
10/30/2024
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