Provider Demographics
NPI:1821509761
Name:BULLARD-BATISTE, JASON RAY (DSW, LCSW-BACS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAY
Last Name:BULLARD-BATISTE
Suffix:
Gender:M
Credentials:DSW, LCSW-BACS
Other - Prefix:DR
Other - First Name:JR
Other - Middle Name:
Other - Last Name:BULLARD-BATISTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW, LCSW-BACS
Mailing Address - Street 1:750 S GARRISON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-9604
Mailing Address - Country:US
Mailing Address - Phone:504-400-4204
Mailing Address - Fax:
Practice Address - Street 1:750 S GARRISON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-9604
Practice Address - Country:US
Practice Address - Phone:504-400-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA125861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical