Individual
DR. MARY ELIZABETH BULLOCK-REST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
130 E POPLAR ST, FAYETTEVILLE, AR 72703-2532
(479) 799-1806
Mailing address
130 E POPLAR ST, FAYETTEVILLE, AR 72703-2532
(479) 799-1806
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
95-14P
AR
103T00000X
Psychologist
Primary
PSY-95-14
AR
Other
Enumeration date
03/01/2007
Last updated
09/22/2014
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