Individual ProviderMadelyn Elisabeth BullardMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5661 Keith Ave, Oakland, CA 94618-1542(510) 345-5173(818) 321-0537PECOS EnrollmentBased on the most recent information from CMS, provider Madelyn Elisabeth Bullard does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1922794346Provider TypeIndividualFull NameBullard, Madelyn ElisabethCredentialAMFTGenderFemaleSole ProprietorYesEnumeration Date4/18/2023Last Updated4/18/2023Contact InformationPractice LocationPractice Address5661 Keith Ave, Oakland, CA 94618-1542Phone(510) 345-5173FaxUnlisted FaxMailing LocationMailing Address1210 Bonita Ave Rear Unit, Berkeley, CA 94709-1923Phone(818) 321-0537FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense129337California