Individual
DR. MARK DANA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
6160 E HAYDEN LAKE RD, HAYDEN, ID 83835-7594
(208) 699-8044
Mailing address
6160 E HAYDEN LAKE RD, HAYDEN, ID 83835-7594
(208) 699-8044
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-988
ID
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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