Individual
B GRACE MARIE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
559 FULVUE DR, EUGENE, OR 97405-2794
(541) 852-2520
Mailing address
559 FULVUE DRIVE, EUGENE, OR 97405-2794
(541) 852-2520
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
09/12/2008
Last updated
10/25/2012
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