MEDICARE: DR. LEWIS A BULLOCK NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	225797	MS

General Provider Information

NPI Number	:	1336371053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS A BULLOCK NCC

Provider Business Mailing Address
First Line	:	PO BOX 15324
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39404-5324
Country	:	US
Telephone Number	:	601-768-7272
Fax Number	:	601-448-6947

Provider Business Practice Location Address
First Line	:	15 PROFESSIONAL PKWY STE 100
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-2647
Country	:	US
Telephone Number	:	601-768-7272
Fax Number	:	601-768-2429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	02/15/2026

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