Individual
MARTHA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 DEERMOUNT ST, KETCHIKAN, AK 99901-6649
(907) 228-4900
Mailing address
2960 TONGASS AVE, KETCHIKAN, AK 99901-5742
(907) 228-4900
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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