Individual
JAMIE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
127 KALE CT, SAINT ROBERT, MO 65584-3816
(573) 261-8140
Mailing address
PO BOX 4067, WAYNESVILLE, MO 65583-4067
(573) 774-5353
(573) 774-2907
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
7924
MO
101YM0800X
Mental Health Counselor
Primary
2014015460
MO
Other
Enumeration date
06/13/2014
Last updated
11/18/2021
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