Provider Demographics
NPI:1174743561
Name:BULGATZ, SHAWN MICHAEL (LMFT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:BULGATZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 FEDERAL DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3501
Mailing Address - Country:US
Mailing Address - Phone:651-452-2305
Mailing Address - Fax:651-452-2796
Practice Address - Street 1:3440 FEDERAL DR
Practice Address - Street 2:SUITE 140
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3501
Practice Address - Country:US
Practice Address - Phone:651-452-2305
Practice Address - Fax:651-452-2796
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist