Individual
MARY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7437 COBBLESTONE EAST DR, INDIANAPOLIS, IN 46236-9108
(317) 418-7840
Mailing address
7437 COBBLESTONE EAST DR, INDIANAPOLIS, IN 46236-9108
(317) 418-7840
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11 MENTAL HEALTH
—
IN
05
—
611-1915(I) CMHW
—
IN
Enumeration date
10/13/2014
Last updated
10/13/2014
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