Provider Information for 1972135655
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MONICA BULLOCK LPC
Sex: Female
NPI: 1972135655
Last Updated: 2023-05-01
Certification Date: 2023-05-01
Certification Date: 2023-05-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972135655 | ||||||||||||
| Enumeration Date | 2020-02-10 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 701 E MARSHALL AVE STE 310 LONGVIEW, TX 75601-5544 United States Phone: 903-234-9200 | Fax: | ||||||||||||
| Primary Practice Address | 701 E MARSHALL AVE STE 310 LONGVIEW, TX 75601-5544 United States Phone: 903-234-9200 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 559 N MARLBOROUGH CIR | ||||||||||||
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