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General NPI Number Information
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NPI Number | 1649304452
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Entity Type | Individual
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Provider Name | WESLEY ALLEN BULLOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 2801 W BANCROFT ST UNIVERSITY OF TOLEDO, DEPT. OF PSYCHOLOGY # 948
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City | TOLEDO
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State | OH
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Zip | 43606-3328
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Country | US
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Telephone | 419-530-2721
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Fax | 419-530-8479
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Provider Business Mailing Address
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Address Line | 2801 W BANCROFT ST UNIVERSITY OF TOLEDO, DEPT. OF PSYCHOLOGY # 948
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City | TOLEDO
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State | OH
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Zip | 43606-3328
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Country | US
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Telephone | 419-530-2721
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Fax | 419-530-8479
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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 | 3856
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License Number State | OH
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