Individual
MRS. TAMARA LATRICE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8113 RED BARN CT, INDIANAPOLIS, IN 46239-7644
(317) 657-6779
Mailing address
8113 RED BARN CT, INDIANAPOLIS, IN 46239-7644
(317) 657-6779
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
172V00000X
Community Health Worker
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
06/27/2025
Last updated
06/27/2025
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