Individual
SHANE M. BULLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
901 S HUNTINGTON ST, SYRACUSE, IN 46567-1923
(574) 457-4400
Mailing address
2621 E JEFFERSON ST, WARSAW, IN 46580-3880
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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