Provider Demographics
NPI:1376682161
Name:BULLOCK, MICHELE LYNN (NCC, LPC, BC-TMH)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:NCC, LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2732
Mailing Address - Country:US
Mailing Address - Phone:203-868-5436
Mailing Address - Fax:
Practice Address - Street 1:55 TENNYSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2732
Practice Address - Country:US
Practice Address - Phone:203-868-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001538101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health