Provider Demographics
NPI:1356708580
Name:HEIDI BULLOCK COUNSELING LLC
Entity type:Organization
Organization Name:HEIDI BULLOCK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/PIP
Authorized Official - Phone:317-650-1165
Mailing Address - Street 1:3 OFFICE PARK CIRCLE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MOUNTAIN BROOK
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:205-912-2000
Mailing Address - Fax:205-945-1890
Practice Address - Street 1:3 OFFICE PARK CIRCLE
Practice Address - Street 2:SUITE 115
Practice Address - City:MOUNTAIN BROOK
Practice Address - State:AL
Practice Address - Zip Code:35223
Practice Address - Country:US
Practice Address - Phone:205-912-2000
Practice Address - Fax:205-945-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2267C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty