Individual
DR. KATE BODACK CULLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3100 E JOHN HINKLE PL STE 104, BLOOMINGTON, IN 47408-2611
(812) 323-6001
Mailing address
3209 S DAWSON LN, BLOOMINGTON, IN 47403-4681
(352) 514-4210
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
20043309B
IN
103TF0000X
Family Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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