Individual
MICAH J BULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
245 E 680 S, CEDAR CITY, UT 84720-3593
(435) 867-7654
(435) 867-7699
Mailing address
2505 IDLEWILDE DR, MIDLAND, TX 79707-6120
(435) 868-8405
(435) 986-8700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
107800
TX
1041C0700X
Clinical Social Worker
8371889
ID
1041C0700X
Clinical Social Worker
Primary
8765778-3501
UT
1041C0700X
Clinical Social Worker
Primary
—
UT
171M00000X
Case Manager/Care Coordinator
—
UT
Other
Enumeration date
09/29/2017
Last updated
04/07/2026
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