# MARY BULLOCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1437553989
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2014
- **Last updated:** 10/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 11 MENTAL HEALTH | — | IN |
| 05 | — | 611-1915(I) CMHW | — | IN |