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Individual

AMANDA BULLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2005 WARREN AVE, CHEYENNE, WY 82001-3725
(307) 426-4855
Mailing address
7308 LEGACY PKWY, CHEYENNE, WY 82009-8392
(307) 272-7743

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PPC-1166
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PPC-1166
WY
Enumeration date
01/09/2020
Last updated
01/09/2020
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