Individual
SHAYNA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
312 MAIN ST, MANGHAM, LA 71259-5277
(318) 330-5859
Mailing address
312 MAIN ST, MANGHAM, LA 71259-5277
(318) 330-5859
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/19/2020
Last updated
02/12/2026
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