KATHLEEN BULLARD PSYCHOTHERAPY LLC NPI 1063993038

NPI Information

  • NPI: 1063993038
  • Provider Name: KATHLEEN BULLARD PSYCHOTHERAPY LLC
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Organization
  • Doing Business As: KB PSYCHOTHERAPY & EMDR
  • Address: 647 W MAIN ST
    LAKE GENEVA, WI
    ZIP 53147
  • Phone: (262) 806-1467

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NPI Details

KATHLEEN BULLARD PSYCHOTHERAPY LLC is an addiction (substance use disorder) counselor in Lake Geneva, WI. KATHLEEN BULLARD PSYCHOTHERAPY LLC NPI is 1063993038. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Kb Psychotherapy & Emdr.

The provider's business location address is:

647 W MAIN ST
LAKE GENEVA, WI
ZIP 53147-990
Phone: (262) 806-1467

The provider's authorized official is Kate M Bullard .
The authorized official title is Owner/psychotherapist and has the following contact phone number (847) 809-9218.

The enumeration date for this NPI number is 8/27/2018 and was last updated on 10/17/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)16105-131WISCONSINYes
2101YP2500XCounselorProfessional6363-125WISCONSINNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11033550934MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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