Individual
JENNIFER BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., M.L.S.P.
Contact information
Practice address
245 S 16TH ST, PHILADELPHIA, PA 19102-3303
(215) 957-5073
(215) 887-7369
Mailing address
245 S 16TH ST, PHILADELPHIA, PA 19102-3303
(215) 957-5073
(215) 887-7369
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PC004367
PA
Other
Enumeration date
11/12/2008
Last updated
11/12/2008
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