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General NPI Number Information
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NPI Number | 1407124381
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Entity Type | Individual
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Provider Name | CODY L. BULLOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 2601 VETERANS DR DR. BULLOCK - 116B
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-291-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 VETERANS DR DR. BULLOCK - 116B
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-291-9201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2109
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License Number State | KS
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