Provider Demographics
NPI:1972135655
Name:BULLOCK, MONICA (LPC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E MARSHALL AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5544
Mailing Address - Country:US
Mailing Address - Phone:903-234-9200
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL AVE STE 310
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5544
Practice Address - Country:US
Practice Address - Phone:903-234-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9306101YP2500X
TX80129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional