Provider Demographics
NPI:1275655961
Name:HENDERSON BULLOCK, WENDY SUE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:SUE
Last Name:HENDERSON BULLOCK
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S ONEIDA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2558
Mailing Address - Country:US
Mailing Address - Phone:303-433-1975
Mailing Address - Fax:303-433-1980
Practice Address - Street 1:13731 E RICE PL STE 105
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1063
Practice Address - Country:US
Practice Address - Phone:720-696-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2503101YP2500X
COLPC2503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
61455784Medicare UPIN